- Email: [email protected]
EP-1159: Outcomes of involved-field particle radiotherapy for stage II-III nonsmall cell lung cancer
S40
ESTRO 33, 2014
Table 1. Recurrence patterns and the causes of death.
Recurrence patterns
Causes of death
Local Regional Locoregional Distant Lung cancer · Local/regional progression · Distant progression Other causes Unknown
Patients (n)
Patients (%)
2/13 2/13 4/13 5/13
15.4 15.4 30.7 38.5
1/10 4/10 3/10 2/10
10.0 40.0 30.0 20.0
Conclusions: SRT offers effective local tumour control with acceptable toxicity rates for early stage lung tumours. The predominant pattern for recurrence is out-of-field. Long-term follow-up is required in order to detect risk factors for disease progression. EP-1158 A randomized comparison of two schedules of hypofractionated radiotherapy for palliation of symptoms from NSCLC P. Sahai1, P.K. Mohanta1, A.K. Bahadur1, M.K. Daga2, A.K. Rathi1, K. Singh1 1 Maulana Azad Medical College, Radiation Oncology, New Delhi, India 2 Maulana Azad Medical College, Medicine, New Delhi, India Purpose/Objective: To compare two schedules of hypofractionated radiotherapy with reference to the extent of relief of symptoms, time to achieve relief, duration of relief, and treatment-related morbidities. Materials and Methods: Forty eligible patients needing palliation of thoracic symptoms from advanced non-small cell lung cancer (stage IIIB and IV) were randomized into two arms. One arm of patients was treated with 17 Gy in 2 fractions 3 weeks apart (Arm A, n=20) whereas the other one with 17 Gy in 2 fractions 1 week apart (Arm B, n=20). The patients were assessed for a period of 3 months following the first fraction of radiotherapy. The assessment was noted at weekly intervals for first month, two weekly for second month, and then monthly. Results: The median age of the patients was 60 years (range, 40-81 years). The thoracic symptoms at presentation in arm A were as follows: cough (n=19), haemoptysis (n=10), dyspnoea (n=20), chest pain (n=19), and hoarseness (n=9). The symptoms at presentation in arm B were as follows: cough (n=19), haemoptysis (n=8), dyspnoea (n=19), chest pain (n=16),and hoarseness (n=11). The percentage of patients reporting symptom relief after radiotherapy is listed in Table 1. Table 1: The percentage of patients reporting symptom relief after radiotherapy Symptom Arm A Arm B p value Cough 42% 37% 0.99 Haemoptysis 90% 88% 0.71 Dyspnoea 50% 37% 0.61 Chest pain 79% 63% 0.24 Hoarseness 22% 18% 0.63 There was no statistically significant difference in the mean scores of symptoms at respective weeks between arm A and B. The improvement in the score for haemoptysis and chest pain was evident within a week of first fraction of radiotherapy. The time to achieve relief in cough and dyspnoea was after two weeks of first fraction. A median of 72 days and 52 days of symptom improvement was observed in arm A and B, respectively (p=0.26). Symptom palliation was achieved for a median of 85% and 69% of the assessment duration or survival time for arm A and B, respectively (p=0.21). With respect to the treatment-related morbidities, a significant difference in the mean score of anorexia between arm A and B at week 2 (p=0.02) and week 3 (p=0.04) was noted. The mean score was higher i.e., more anorexia in arm B. Similarly for dysphagia, the mean score was higher i.e., more dysphagia in arm B at week 2 (p=0.002) and week 3 (p=0.001). No significant difference was recorded at week 4, 6, 8, and 12. No patient in this study developed radiation pneumonitis or myelopathy. Conclusions: Hypofractionated radiotherapy is an effective and convenient modality for symptom palliation. The best palliation rates were achieved for haemoptysis and chest pain. The interval of three weeks between the two fractions may be considered in order to reduce treatment-related morbidities like anorexia and dysphagia.
EP-1159 Outcomes of involved-field particle radiotherapy for stage II-III nonsmall cell lung cancer O. Fujii1, Y. Demizu1, N. Hashimoto1, M. Takagi1, K. Terashima1, M. Mima1, D. Jin1, N. Fuwa1, Y. Niwa2, M. Murakami3 1 Hyogo Ion Beam Medical Center, Radiology, Tatsuno, Japan 2 Hyogo College of Medicine, Radiology, Nishinomiya, Japan 3 Dokkyo Medical University, Radiation Oncology, Tochigi, Japan Purpose/Objective: Limited clinical data exists in the use of involvedfield radiotherapy (IFRT) for stage II and III non-small cell lung cancer (NSCLC). The purpose of this study was to analyze outcomes, prognostic factors and adverse effects of IFRT using protons or carbon ions for stage II and III NSCLC at Hyogo Ion Beam Medical Center (HIBMC) retrospectively. Materials and Methods: A total of 81 patients who underwent IFRT using protons (n = 38) or carbon ions (n = 43) for stage II and III between April 2004 and December 2012 were enrolled in this study. Median age was 76 years (range, 46-92). Thirty-nine patients had squamous cell carcinoma (SCC), 29 had adenocarcinoma and 13 had others. Seventy patients were considered unsuitable for surgery and 11 refused surgery. The lung cancer was staged as IIA, 32; IIB, 19; IIIA, 23; and IIIB, 7. Planned total doses ranged from 60 to 80 GyE in patients treated with proton therapy and from 52.8 to 80 GyE in patients with carbon ion therapy. No patients received chemotherapy during RT. Results: Eighty patients (99%) completed planned treatment. The median follow-up time for all patients was 22 months (range, 4-94 months). Local progression, elective nodal and distant metastases occurred in 26 patients (33%), 11 patients (14%) and 32 patients (40%), respectively. The actuarial 2-year rates of overall survival (OS), progression-free survival and local control for patients with stage IIA, IIB and III were 72%, 70%, 58% (p = 0.054), 56%, 45%, 10% (p =0.002) and 88%, 58%, 35% (p = 0.024), respectively. There was no significant difference in outcomes between the proton and carbon ion therapy groups. The 2-year OS rate for patients with adenocarcinoma was higher than that for patients with SCC (88% and 46%, respectively). Multivariate analysis revealed that histological type was only independent prognostic factor for OS (p = 0.032). As for late toxicities, grade3, 4 and 5 events occurred in 5 patients (pneumonitis, 4; pneumothorax, 1), 1 patient (dermatitis) and 3 patients (hemoptysis, 2; pneumonitis, 1), respectively. Conclusions: This study showed that IFRT using protons or carbon ions for stage II and III NSCLC could be a promising treatment option especially for medically inoperable patients. SCC is associated with inferior outcomes and may require additional treatment for better disease control. More accumulation of patients and longer follow-up would be warranted. EP-1160 Endobronchial implantation of fiducial markers for image guidance in lung cancer radiotherapy T. Kron1, S. Siva2, D. Steinfort3, B. Chesson4, N. Hardcastle1, L. Irving3, D. Ball2 1 Peter MacCallum Cancer Centre, Physical Sciences, East Melbourne, Australia 2 Peter MacCallum Cancer Centre, Radiation Oncology, East Melbourne, Australia 3 Royal Melbourne Hospital, Respiratory Medicine, Melbourne, Australia 4 Peter MacCallum Cancer Centre, Radiation Therapy, East Melbourne, Australia Purpose/Objective: Stereotactic radiotherapy is a high-dose precision technique necessitating accurate target visualisation. While cone beam computed tomography (CBCT) is an option to visualise lung tumours it is time consuming, cannot assess motion accurately with the majority of current technology and cannot be taken during the treatment delivery itself. As percutaneous insertion of fiducials for image guidance is associated with significant risk of pneumothorax, we have investigated the use of fiducial markers implanted through minimally invasive bronchoscopy. Materials and Methods: In this ethics board approved prospective study two types of fiducial markers were implanted endobronchially in eight patients undergoing radiation treatment for non-small cell lung cancer (six using VisicoilTM linear fiducial 10x0.75mm marker, two using SuperDimension® superLock™ 2-band 13x0.9mm markers, compare figure 1). The bronchoscopic implantation was performed under conscious sedation using radial probe endobronchial ultrasound (EBUS) and fluoroscopic guidance to achieve tumour localization and placement within/adjacent to peripheral lung tumours. Patients had a time
ESTRO 33, 2014
Table 1. Recurrence patterns and the causes of death.
Recurrence patterns
Causes of death
Local Regional Locoregional Distant Lung cancer · Local/regional progression · Distant progression Other causes Unknown
Patients (n)
Patients (%)
2/13 2/13 4/13 5/13
15.4 15.4 30.7 38.5
1/10 4/10 3/10 2/10
10.0 40.0 30.0 20.0
Conclusions: SRT offers effective local tumour control with acceptable toxicity rates for early stage lung tumours. The predominant pattern for recurrence is out-of-field. Long-term follow-up is required in order to detect risk factors for disease progression. EP-1158 A randomized comparison of two schedules of hypofractionated radiotherapy for palliation of symptoms from NSCLC P. Sahai1, P.K. Mohanta1, A.K. Bahadur1, M.K. Daga2, A.K. Rathi1, K. Singh1 1 Maulana Azad Medical College, Radiation Oncology, New Delhi, India 2 Maulana Azad Medical College, Medicine, New Delhi, India Purpose/Objective: To compare two schedules of hypofractionated radiotherapy with reference to the extent of relief of symptoms, time to achieve relief, duration of relief, and treatment-related morbidities. Materials and Methods: Forty eligible patients needing palliation of thoracic symptoms from advanced non-small cell lung cancer (stage IIIB and IV) were randomized into two arms. One arm of patients was treated with 17 Gy in 2 fractions 3 weeks apart (Arm A, n=20) whereas the other one with 17 Gy in 2 fractions 1 week apart (Arm B, n=20). The patients were assessed for a period of 3 months following the first fraction of radiotherapy. The assessment was noted at weekly intervals for first month, two weekly for second month, and then monthly. Results: The median age of the patients was 60 years (range, 40-81 years). The thoracic symptoms at presentation in arm A were as follows: cough (n=19), haemoptysis (n=10), dyspnoea (n=20), chest pain (n=19), and hoarseness (n=9). The symptoms at presentation in arm B were as follows: cough (n=19), haemoptysis (n=8), dyspnoea (n=19), chest pain (n=16),and hoarseness (n=11). The percentage of patients reporting symptom relief after radiotherapy is listed in Table 1. Table 1: The percentage of patients reporting symptom relief after radiotherapy Symptom Arm A Arm B p value Cough 42% 37% 0.99 Haemoptysis 90% 88% 0.71 Dyspnoea 50% 37% 0.61 Chest pain 79% 63% 0.24 Hoarseness 22% 18% 0.63 There was no statistically significant difference in the mean scores of symptoms at respective weeks between arm A and B. The improvement in the score for haemoptysis and chest pain was evident within a week of first fraction of radiotherapy. The time to achieve relief in cough and dyspnoea was after two weeks of first fraction. A median of 72 days and 52 days of symptom improvement was observed in arm A and B, respectively (p=0.26). Symptom palliation was achieved for a median of 85% and 69% of the assessment duration or survival time for arm A and B, respectively (p=0.21). With respect to the treatment-related morbidities, a significant difference in the mean score of anorexia between arm A and B at week 2 (p=0.02) and week 3 (p=0.04) was noted. The mean score was higher i.e., more anorexia in arm B. Similarly for dysphagia, the mean score was higher i.e., more dysphagia in arm B at week 2 (p=0.002) and week 3 (p=0.001). No significant difference was recorded at week 4, 6, 8, and 12. No patient in this study developed radiation pneumonitis or myelopathy. Conclusions: Hypofractionated radiotherapy is an effective and convenient modality for symptom palliation. The best palliation rates were achieved for haemoptysis and chest pain. The interval of three weeks between the two fractions may be considered in order to reduce treatment-related morbidities like anorexia and dysphagia.
EP-1159 Outcomes of involved-field particle radiotherapy for stage II-III nonsmall cell lung cancer O. Fujii1, Y. Demizu1, N. Hashimoto1, M. Takagi1, K. Terashima1, M. Mima1, D. Jin1, N. Fuwa1, Y. Niwa2, M. Murakami3 1 Hyogo Ion Beam Medical Center, Radiology, Tatsuno, Japan 2 Hyogo College of Medicine, Radiology, Nishinomiya, Japan 3 Dokkyo Medical University, Radiation Oncology, Tochigi, Japan Purpose/Objective: Limited clinical data exists in the use of involvedfield radiotherapy (IFRT) for stage II and III non-small cell lung cancer (NSCLC). The purpose of this study was to analyze outcomes, prognostic factors and adverse effects of IFRT using protons or carbon ions for stage II and III NSCLC at Hyogo Ion Beam Medical Center (HIBMC) retrospectively. Materials and Methods: A total of 81 patients who underwent IFRT using protons (n = 38) or carbon ions (n = 43) for stage II and III between April 2004 and December 2012 were enrolled in this study. Median age was 76 years (range, 46-92). Thirty-nine patients had squamous cell carcinoma (SCC), 29 had adenocarcinoma and 13 had others. Seventy patients were considered unsuitable for surgery and 11 refused surgery. The lung cancer was staged as IIA, 32; IIB, 19; IIIA, 23; and IIIB, 7. Planned total doses ranged from 60 to 80 GyE in patients treated with proton therapy and from 52.8 to 80 GyE in patients with carbon ion therapy. No patients received chemotherapy during RT. Results: Eighty patients (99%) completed planned treatment. The median follow-up time for all patients was 22 months (range, 4-94 months). Local progression, elective nodal and distant metastases occurred in 26 patients (33%), 11 patients (14%) and 32 patients (40%), respectively. The actuarial 2-year rates of overall survival (OS), progression-free survival and local control for patients with stage IIA, IIB and III were 72%, 70%, 58% (p = 0.054), 56%, 45%, 10% (p =0.002) and 88%, 58%, 35% (p = 0.024), respectively. There was no significant difference in outcomes between the proton and carbon ion therapy groups. The 2-year OS rate for patients with adenocarcinoma was higher than that for patients with SCC (88% and 46%, respectively). Multivariate analysis revealed that histological type was only independent prognostic factor for OS (p = 0.032). As for late toxicities, grade3, 4 and 5 events occurred in 5 patients (pneumonitis, 4; pneumothorax, 1), 1 patient (dermatitis) and 3 patients (hemoptysis, 2; pneumonitis, 1), respectively. Conclusions: This study showed that IFRT using protons or carbon ions for stage II and III NSCLC could be a promising treatment option especially for medically inoperable patients. SCC is associated with inferior outcomes and may require additional treatment for better disease control. More accumulation of patients and longer follow-up would be warranted. EP-1160 Endobronchial implantation of fiducial markers for image guidance in lung cancer radiotherapy T. Kron1, S. Siva2, D. Steinfort3, B. Chesson4, N. Hardcastle1, L. Irving3, D. Ball2 1 Peter MacCallum Cancer Centre, Physical Sciences, East Melbourne, Australia 2 Peter MacCallum Cancer Centre, Radiation Oncology, East Melbourne, Australia 3 Royal Melbourne Hospital, Respiratory Medicine, Melbourne, Australia 4 Peter MacCallum Cancer Centre, Radiation Therapy, East Melbourne, Australia Purpose/Objective: Stereotactic radiotherapy is a high-dose precision technique necessitating accurate target visualisation. While cone beam computed tomography (CBCT) is an option to visualise lung tumours it is time consuming, cannot assess motion accurately with the majority of current technology and cannot be taken during the treatment delivery itself. As percutaneous insertion of fiducials for image guidance is associated with significant risk of pneumothorax, we have investigated the use of fiducial markers implanted through minimally invasive bronchoscopy. Materials and Methods: In this ethics board approved prospective study two types of fiducial markers were implanted endobronchially in eight patients undergoing radiation treatment for non-small cell lung cancer (six using VisicoilTM linear fiducial 10x0.75mm marker, two using SuperDimension® superLock™ 2-band 13x0.9mm markers, compare figure 1). The bronchoscopic implantation was performed under conscious sedation using radial probe endobronchial ultrasound (EBUS) and fluoroscopic guidance to achieve tumour localization and placement within/adjacent to peripheral lung tumours. Patients had a time