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EP-1163: Volumetric modulated arc therapy (VMAT)in locally advanced lung cancer ñ dosimetric comparison with 3DCRT
S42 KL-6 and SP-D values were not significantly associated with the RP grades. One patient was diagnosed with a local recurrence 11 months after CIRT. The other patients had no evidence of local recurrence. Conclusions: Carbon ion radiotherapy could be used as a low risk, curative treatment for NSCLC patients with IIP as it is a minimally invasive procedure and has excellent dose localization. EP-1163 Volumetric modulated arc therapy (VMAT)in locally advanced lung cancer ñ dosimetric comparison with 3DCRT G. Reddy1, R.K. Shrimali1, P. Dharmendran1, R. Achari1, I. Mallick1, S. Chatterjee1 1 Tata Medical Center, Radiation Oncology, Kolkata, India Purpose/Objective: IMRT is known to improve the therapeutic ratio in lung cancer by decreasing dose delivery to the spinal cord and lung tissue and improving tumour coverage. In locally advanced disease, dose constraints to organs at risk can be unattainable with 3D CRT planning and until recently such patients received palliative treatment. Materials and Methods: Eight Patients, who would not have been suitable for radical radiotherapy according to our local dose constraints, were planned with VMAT, from March 2012 to October 2013. In all of these patients a complex 3D-CRT plan using 5 fields was attempted multiple times (3 to 6 times) before attempting VMAT plan. A comparative analysis was carried out between the best 3D-CRT plans achieved and the VMAT plan that was actually used to treat the patients. Results: One patient had stage IIB NSCLC and 7 patients stage IIIA/IIIB NSCLC. The histology was equally divided between adenocarcinoma and squamous cell carcinomas. FDG-PET was used to complete staging in all of these patients. Upfront use of concurrent chemo-radiotherapy was now possible in 6 patients, whereas 2 patients received sequential treatments. Reasons for treating with VMAT were as follows: high V20/MLD/both (2 patients), high spinal cord dose (4 patients), both reasons (2 patients). 60 Gy was delivered in 30 fractions using RapidArc. The VMAT plan satisfied the OARs constraints by improving the V-20 for lung and maximum spinal cord dose in all of our 8 cases and made radical radiotherapy with curative intent possible. No major increase in the low-dose bath to the lung was seen, as evident from V-5, V-10 and MLD data. The improvement in conformity index (CI) was dramatic with a mean CI of 0.86 and median CI of 0.88 with VMAT when compared with 0.58 and 0.55 respectively for 3D-CRT. The median Dose Homogeneity Index (DHI) improved from 1.14 for 3D-CRT to 1.07 for VMAT.
ESTRO 33, 2014 Materials and Methods: Hundred and eight stage I NSCLC patients with contraindication to surgery (15% refusal, 20% age, 17% cardiac morbidity,64% pulmonary disease) were treated between February 2007 and May 2013. The median age was 70.8 y.o. (range 45-86). Eleven patients had previous thoracic radiation and twenty eight had previous thoracic surgery. Staging (UICC 2009) wasT1aN0 for 51%, T1bN0 for 36% and T2aN0 for 13% of patients. Histology was available for 60,1 % of the patients (squamous 19.7%, adenocarcinoma 19.7%, NSCLCNOS 20.7%). Ninety-two patients were treated with 4 fractions of 12 Gy and 16 patients with more central lesion were treated with 8 fractions of 7,5 Gy or 3 fractions of 20 Gy. Thermoplastic masks were personalized, some with diaphragmatic compression. The InternalTarget Volume (ITV) was built with 3-10 breathing phases. The Planning Target Volume margin was 5 mm. Sixteen patients were treated on HelicalTomotherapy, the others were treated with coplanar and non-coplanar 3DCRT with pencil beam dose calculation or with Rapidarc delivery and AAA calculation. Amorphous silicon portal imaging, MVCT, or ConeBeam CT online set up correction were performed. The ITV was always covered by the 95% isodose line, the PTV by the80-100 % isodose line. All uncertain post treatment images were classified asrelapses. Results: At a median follow-up of 24,7 months (range1-78), local control, disease free survival, and overall survival are 68%, 61.5%, and 80% respectivelyfor all patients. Acute lung toxicity grade I was seen in 7 patients (7%) and grade III (requiring steroids) in 2 patients (2%). At 3 months, complete response,partial response, stable disease and progression were observed in 23, 48, 29 and 1 patient respectively (6 unknown). To date (November 2013), 46 patients had developed recurrences (34 local, 1 nodal only, 11 distant metastasis with/withoutnodal recurrences). Median survival is 22.9 months. Fatigue was reported in 41.6%, esophagitis in 2%, dermatitis 3%, others including pain 10.2%. Conclusions: Lung SABR has a confirmed efficacy and limited toxicity. The observed 68% local control is likely explained by the inclusion of 13 % of larger lesions and the use of earlier technologies for initia lpatients. EP-1165 Initial outcomes results in lung cancer treatment with VMAT M. Gómez1, A. Iglesias1, P. Escolar1, J. Salinas1 1 Hospital Santa Lucia, Radiation Oncology, Cartagena, Spain Purpose/Objective: To report acute toxicity, quality of life (QOL) and dosimetric parameters in radiation treatment of advanced lung cancer with Volumetric Modulated Arc Therapy (VMAT)–Rapid Arc and IGRT (Image Guided Radiation Therapy) Materials and Methods: One hundred and eleven consecutive patients with inoperable tumour (stage IIIA-IIIB) were treated with VMAT. Mean dose: 66.28 Gy (range 60-74 Gy). Treatment delivery was performed with two partial or total arcs. IGRT was made with daily Cone-Beam CT. Acute toxicity was scored following CTC criteria and QOL with EORTCQOL-C30 and EORTC-QLQ-LC13. Dose constrains were: Spinal Cord: D1%< 46 Gy, Lung: V20Gy < 30%; Mean Lung Dose (MLD) < 17 Gy, Heart V45Gy < 30%; Esophagus: V66Gy < 33%; V35Gy < 50% ;Mean Esophagus Dose < 34 Gy
Conclusions: Although resource intensive, VMAT enables us to treat more patients with curative intent using radical radiotherapy. Target volume coverage (CI) and dose homogeneity (DHI) was found to be improved without any substantial deterioration in the low dose bath to the lung. Follow-up is short and the impact of this technique on toxicity, local control and survival will need to be evaluated in further studies. EP-1164 A retrospective study of lung stereotactic radiotherapy: 24,3 months of follow up S. Bougas1, C. Ninane2, S. Palumbo1, A. Baudoux1, F. Bustin3, F. Duplaquet4, F. Maisin1, S. Ocak4, G. Vandermoten5, V. Remouchamps1 1 Clinique St. Elisabeth, Radiotherapy, Namur, Belgium 2 Clinique St. Elisabeth, Data management, Namur, Belgium 3 CHR La Citadelle, Pneumology, Liège, Belgium 4 CHU Mont-Godinne, Pneumology, Yvoir, Belgium 5 CHR Namur, Pneumology, Namur, Belgium Purpose/Objective: To retrospectively review stage I Non Small Cell Lung Cancer (NSCLC) patients treated with Stereotactic Ablative Body Radiotherapy (SABR) in our institution in the context of a multicentric integrated collaboration.
Results: From a dosimetric point of view, VMAT plan fulfilled all our dose constrains. (Table 1) (Figure1) Mean dose coverage 95% PTV volume was: 98,66 ± 1,03%. LUNG V5Gy= 58,57 ± 14,95%, V10Gy = 41,17 ± 13.03%, V20Gy= 21.97 ± 6.33%, MLD= 13,31 ± 3,67Gy; for esophagus V66Gy = 2,93 ± 4,87%, V50Gy = 15,92 ± 13,70%, V35Gy= 27,78 ± 16,64% and mean esophagus dose= 21.29 ± 8,88Gy; for spinal cord D1%= 31.68 ± 9,69Gy; for heart V45Gy = 3.23 ± 5,70%. Acute toxicities were 2 patients with grade 3 esophageal toxicity, 6 with grade 2 and 103 with grade 0-1. No other toxicities were observed. QLQ-C30 showed between start to end of the treatment: cough and haemoptysis improved and dysphagia worsened. No changes in dysnea were observed. QLQ-LC13:Physical and role functioning improved while asthenia and appetite loss worsened.
ESTRO 33, 2014 Materials and Methods: Hundred and eight stage I NSCLC patients with contraindication to surgery (15% refusal, 20% age, 17% cardiac morbidity,64% pulmonary disease) were treated between February 2007 and May 2013. The median age was 70.8 y.o. (range 45-86). Eleven patients had previous thoracic radiation and twenty eight had previous thoracic surgery. Staging (UICC 2009) wasT1aN0 for 51%, T1bN0 for 36% and T2aN0 for 13% of patients. Histology was available for 60,1 % of the patients (squamous 19.7%, adenocarcinoma 19.7%, NSCLCNOS 20.7%). Ninety-two patients were treated with 4 fractions of 12 Gy and 16 patients with more central lesion were treated with 8 fractions of 7,5 Gy or 3 fractions of 20 Gy. Thermoplastic masks were personalized, some with diaphragmatic compression. The InternalTarget Volume (ITV) was built with 3-10 breathing phases. The Planning Target Volume margin was 5 mm. Sixteen patients were treated on HelicalTomotherapy, the others were treated with coplanar and non-coplanar 3DCRT with pencil beam dose calculation or with Rapidarc delivery and AAA calculation. Amorphous silicon portal imaging, MVCT, or ConeBeam CT online set up correction were performed. The ITV was always covered by the 95% isodose line, the PTV by the80-100 % isodose line. All uncertain post treatment images were classified asrelapses. Results: At a median follow-up of 24,7 months (range1-78), local control, disease free survival, and overall survival are 68%, 61.5%, and 80% respectivelyfor all patients. Acute lung toxicity grade I was seen in 7 patients (7%) and grade III (requiring steroids) in 2 patients (2%). At 3 months, complete response,partial response, stable disease and progression were observed in 23, 48, 29 and 1 patient respectively (6 unknown). To date (November 2013), 46 patients had developed recurrences (34 local, 1 nodal only, 11 distant metastasis with/withoutnodal recurrences). Median survival is 22.9 months. Fatigue was reported in 41.6%, esophagitis in 2%, dermatitis 3%, others including pain 10.2%. Conclusions: Lung SABR has a confirmed efficacy and limited toxicity. The observed 68% local control is likely explained by the inclusion of 13 % of larger lesions and the use of earlier technologies for initia lpatients. EP-1165 Initial outcomes results in lung cancer treatment with VMAT M. Gómez1, A. Iglesias1, P. Escolar1, J. Salinas1 1 Hospital Santa Lucia, Radiation Oncology, Cartagena, Spain Purpose/Objective: To report acute toxicity, quality of life (QOL) and dosimetric parameters in radiation treatment of advanced lung cancer with Volumetric Modulated Arc Therapy (VMAT)–Rapid Arc and IGRT (Image Guided Radiation Therapy) Materials and Methods: One hundred and eleven consecutive patients with inoperable tumour (stage IIIA-IIIB) were treated with VMAT. Mean dose: 66.28 Gy (range 60-74 Gy). Treatment delivery was performed with two partial or total arcs. IGRT was made with daily Cone-Beam CT. Acute toxicity was scored following CTC criteria and QOL with EORTCQOL-C30 and EORTC-QLQ-LC13. Dose constrains were: Spinal Cord: D1%< 46 Gy, Lung: V20Gy < 30%; Mean Lung Dose (MLD) < 17 Gy, Heart V45Gy < 30%; Esophagus: V66Gy < 33%; V35Gy < 50% ;Mean Esophagus Dose < 34 Gy
Conclusions: Although resource intensive, VMAT enables us to treat more patients with curative intent using radical radiotherapy. Target volume coverage (CI) and dose homogeneity (DHI) was found to be improved without any substantial deterioration in the low dose bath to the lung. Follow-up is short and the impact of this technique on toxicity, local control and survival will need to be evaluated in further studies. EP-1164 A retrospective study of lung stereotactic radiotherapy: 24,3 months of follow up S. Bougas1, C. Ninane2, S. Palumbo1, A. Baudoux1, F. Bustin3, F. Duplaquet4, F. Maisin1, S. Ocak4, G. Vandermoten5, V. Remouchamps1 1 Clinique St. Elisabeth, Radiotherapy, Namur, Belgium 2 Clinique St. Elisabeth, Data management, Namur, Belgium 3 CHR La Citadelle, Pneumology, Liège, Belgium 4 CHU Mont-Godinne, Pneumology, Yvoir, Belgium 5 CHR Namur, Pneumology, Namur, Belgium Purpose/Objective: To retrospectively review stage I Non Small Cell Lung Cancer (NSCLC) patients treated with Stereotactic Ablative Body Radiotherapy (SABR) in our institution in the context of a multicentric integrated collaboration.
Results: From a dosimetric point of view, VMAT plan fulfilled all our dose constrains. (Table 1) (Figure1) Mean dose coverage 95% PTV volume was: 98,66 ± 1,03%. LUNG V5Gy= 58,57 ± 14,95%, V10Gy = 41,17 ± 13.03%, V20Gy= 21.97 ± 6.33%, MLD= 13,31 ± 3,67Gy; for esophagus V66Gy = 2,93 ± 4,87%, V50Gy = 15,92 ± 13,70%, V35Gy= 27,78 ± 16,64% and mean esophagus dose= 21.29 ± 8,88Gy; for spinal cord D1%= 31.68 ± 9,69Gy; for heart V45Gy = 3.23 ± 5,70%. Acute toxicities were 2 patients with grade 3 esophageal toxicity, 6 with grade 2 and 103 with grade 0-1. No other toxicities were observed. QLQ-C30 showed between start to end of the treatment: cough and haemoptysis improved and dysphagia worsened. No changes in dysnea were observed. QLQ-LC13:Physical and role functioning improved while asthenia and appetite loss worsened.