- Email: [email protected]
EP-1199: Radiotherapy for pN2 EGFR wide type adenocarcinoma & Squamous Cell Carcinoma lung cancer
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Material and Methods Between June 2010 and March 2016, 25 patients with locally advanced breast cancer, who underwent modified radical mastectomy, IR, and PMRT were treated at our center. RT was delivered to the chest wall ± nodal areas according to stage, with 6MV and total dose of 50 Gy in 25 fractions. Complications were scored following the CTCAE 4.0 criteria. The capsular contracture was evaluated following the Baker classification. Cosmesis was rated as either acceptable or unacceptable to the patient. Results The mean age was 46.7 years (range, 33-65). A total of 20 patients underwent tissue expander and 5 underwent implant (TE/I). Median follow-up (from the start of RT) for all patients was 18 months (m) (4-48m). 40% of the patients were never smokers; 28% were smokers and 32% ex-smokers during RT. 10% and 68% of the patients received neoadjuvant and adjuvant chemotherapy respectively, and 17 patients taking Tamoxifen during RT. After surgery the complications occurred in 15/25 patients: 7 with capsulitis grade (G) 2; 2 with capsulitis G3-4; 3 with cutaneous suffering and mastitis, extrusion and hematoma were presented in 1 patient each. Complications post surgery in 2 patients as were hematoma and extrusion required additional surgery and delayed beginning of RT. All patients completed the RT course without major complications. During RT the only complication presented was skin erythema (SE) G1-2 seen in 20 (80%) and G3 in just 5 patients which were all smokers. During the follow up the major complications were: capsulitis G3 in 5 patients and G4 in 1; skin hyperpigmentation was presented in 4 patients, cutaneous thinning in 6 and 1 patient presented relevant lung toxicity. At the end of the follow-up, TE Exchange have been realized in 12 patients with a mean time after RT of 14,3m (9-22), 3 of them are pending of a new corrective surgery, specialy for improve cosmetic outcomes. We reported capsulitas G4 in 2 patients after the Exchange; both were smokers and 1 of them presented extrusion before RT, therefore she was operated twice. Acceptable cosmesis was reported in 60% of the patients Conclusion Our experiences is limited but in our patients undergoing PMRT, RT can be safely delivered after IR, with a low complication rate and good patient satisfaction. In our patients major complications occurred before RT. Further studies are needed to define the factors that may be related to worse aesthetic results. EP-1198 Low risk breast cancer patients' supportive care needs and perceptions of follow-up care options J. Kwan1, J. Croke1, J. Bender2, T. Panzarella1, K. Ubhi1, F. Liu1, A. Fyles1, A. Koch1, R. Dinniwell1, W. Levin1, D. McCready3, C. Chung1 1 Princess Margaret Cancer Centre- University Health Network/ University of Toronto, Radiation Oncology, Toronto, Canada 2 University Health Network, ELLICSR Cancer Survivorship Centre, Toronto, Canada 3 Princess Margaret Cancer Centre- University Health Network/ University of Toronto, Surgical Oncology, Toronto, Canada Purpose or Objective Breast cancer is the most common cancer in women and survival following treatment is rising. Although traditional follow-up care has been by oncology specialists posttreatment, literature over the last decade has shown that non-specialist follow-up care is a safe alternative for early-stage breast cancer patients. Barriers in transitioning patients from oncologist follow-up have not been well characterized. This study aims to assess i) the existing follow-up practices at a large institution, ii) met
and unmet supportive care needs, and iii) patient views on alternative care models, particularly involving primary care and eHealth. Material and Methods A cross-sectional survey of well breast cancer patients attending radiation oncology follow-up appointments from August 2012 to May 2013 at the Princess Margaret Cancer Centre (Toronto, Canada) was completed. Eligibility criteria included English-speaking patients with T2 or lower tumor stage, node negative status, and ER/PRpositive breast cancer treated with radiation. Four domains were assessed: health care service use, supportive care needs, perceptions of follow-up care options, and internet usage. Descriptive statistics were completed for all variables and univariable analyses were performed to examine relationships between key variables and domains. Results Response rate was 80% (191/259). Respondents had a mean age of 60 (SD=10.6). Median time since first followup was 21 months. The majority of respondents (161/191; 84%) received follow-up care from greater than one cancer specialist and had a median of 3 health care professional visits per year. The most preferred follow-up model was specialist care at a tertiary centre (178/191; 93%) and the least preferred models were specialist care through video conferencing (29/191; 15%) and email (28/191; 15%). Shared care models involving a specialist and family physician were modestly accepted (103/191; 54%). Primary care only follow-up was not well accepted (35/191; 18%), particularly among patients with higher education. Respondents who reported few unmet supportive care needs (p=0.01) or who search online for health information (p=0.02) were more likely to report perceived satisfaction with specialist follow-up via eHealth. Conclusion Specialist health care services continue to be utilized by early-stage breast cancer patients during the posttreatment period. Transitioning patients to alternative follow-up models may be difficult due to strong patient preference for specialist care. Based on this survey, a minority of patients are willing to accept shared care with family physicians or eHealth follow-up via videoconferencing or email at this time. Electronic Poster: Clinical track: Lung EP-1199 Radiotherapy for pN2 EGFR wide type adenocarcinoma & Squamous Cell Carcinoma lung cancer S.Y. Wu1 1 Taipei Medical University Hospital, No.111- Section 3 Department of Radiation Oncology, Taipei, Chinese Taipei Purpose or Objective There is a lack of large, prospective, randomized studies comparing postoperative radiotherapy (PORT) in pathological N2 (pN2) and surgical resection alone in terms of long-term survival in the setting of lung adenocarcinoma (adenoCA; wild-type [WT] epidermal growth factor receptor [EGFR]) and squamous cell carcinoma (squCA). This national cohort study clarifies the role of PORT in the survival of pN2 lung adenoCA (WT EGFR) and squCA. Material and Methods We analyzed data of patients with adenoCA (WT EGFR) and squCA collected from the Taiwan Cancer Registry database. The patients were categorized into five groups according to the treatment modality: Group 1, comprising
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those undergoing surgery alone; Group 2, comprising those undergoing adjuvant chemotherapy (CT) alone; Group 3, comprising those undergoing adjuvant radiotherapy (RT) alone; Group 4, comprising those receiving adjuvant concurrent chemoradiotherapy; and Group 5, comprising those receiving adjuvant sequential CT and intensity modulation RT. Results We enrolled 588 lung adenoCA (WT EGFR) and squCA patients without distant metastasis. After adjustments for age at surgery, surgical years, and Charlson comorbidity index scores, the multivariate Cox regression analysis demonstrated that adjusted HRs (aHRs; 95% confidence intervals [CIs]) for the overall mortality of female lung adenoCA (WT EGFR) patients were 0.257 (0.111–0.594), 0.530 (0.226–1.243), 0.192 (0.069–0.534), and 0.399 (0.172–0.928) in Groups 2, 3, 4, and 5, respectively. For male lung squCA patients, the aHRs (95% CIs) for overall mortality were 0.269 (0.160–0.451), 0.802 (0.458–1.327), 0.597 (0.358–0.998), and 0.456 (0.265–0.783) in Groups 2, 3, 4, and 5, respectively. Conclusion Adjuvant CCRT or sequential CT and IMRT ≥5000 cGy significantly reduced the mortality rate of female lung adenoCA (WT EGFR) and male squCA pN2 patients. EP-1200 Early versus late PORT for pathologic stage IIIA-N2 NSCLC: a multi-institutional retrospective study M.B. Meng1, H.H. Wang1, L. Deng2, Q.L. Wen3, C.Z. Zhang4, X.L. Zeng1, Y.L. Cui5, Z.Y. Yuan1, P. Wang1 1 Tianjin Medical University Cancer Institute & Hospital, Department of Radiation Oncology, tianjin, China 2 West China Hospital- West China of Medical SchoolSichuan University, Department of Thoracic Cancer, Chengdu, China 3 Affiliated Hospital of Southwest Medical University, Department of Oncology, Luzhou, China 4 Nankai University Tianjin People’s Hospital, Department of Surgery, Tianjin, China 5 Tianjin Medical University Cancer Institute & Hospital, Department of Lymphoma, tianjin, China Purpose or Objective The aim of this study was to evaluate the effect of the time of postoperative radiotherapy (PORT) in combined modality treatment for pathologic stage IIIA-N2 non-small cell lung cancer (NSCLC). Material and Methods Between January 2008 and December 2015, patients with pathologic stage IIIA-N2 NSCLC were enrolled and treated with PORT concurrent with or sequential to fewer than three cycles of postoperative chemotherapy (POCT, early PORT) or with PORT administered after at least four cycles of POCT (late PORT) at multiple hospitals. The primary end point was overall survival (OS); secondary end points included pattern of the first failure, locoregional recurrence-free survival (LRRFS), and distant metastasisfree survival (DMFS). Kaplan–Meier OS, LRRFS, and DMFS curves were compared with the log-rank test. Cox regression analysis was used to determine prognosticators for OS, LRRFS, and DMFS. Results Of 112 included patients, 41 (36.61%) and 71 (63.39%) patients received early PORT and late PORT, respectively. The median OS, LRRFS, and DMFS were longer for those who received early PORT than for those who received late PORT at the median follow-up of 29.6 months (all p < 0.05). Uni- and multi-variate analyses showed that number of POCT cycles and the combination schedule of PORT and POCT were independent prognostic factors for OS, LRRFS, and DMFS.
Conclusion Pathologic stage IIIA-N2 NSCLC patients treated with early PORT experienced better OS, LRRFS, and DMFS than those treated with late PORT. Thus, early PORT should be considered as a primary approach for those patients. EP-1201 SLR versus SBRT for high-risk elderly patients with stage I NSCLC H.H. Wang1, M.B. Meng1, X.L. Zeng1, L. Deng2 1 Tianjin Medical University Cancer Institute & Hospital, Department of Radiation Oncology, , China 2 West China Hospital- West China School of MedicineSichuan University, Department of Thoracic Cancer, Tanjin, China Purpose or Objective The purpose of this study was to evaluate the efficacy and safety of radiotherapy (RT) for high-risk elderly patients with stage I non-small cell lung cancer (NSCLC) through a meta-analysis of data from published studies comparing sublobar resection (SLR) with RT including conventional fraction radiation therapy (CFRT) and stereotactic body radiation therapy (SBRT). Material and Methods We searched the Cochrane Library, MEDLINE, CENTRAL, and EMBASE and conducted manual searches. Metaanalysis was performed on the results of homogeneous studies. Analyses subdivided by study design were also performed. Results Based on our search criteria, we found 16 trials involving 11540 patients. Nine were propensity-score matched (PSM) cohort studies, and 7 were cohort studies. Five studies compared SLR with CFRT, and 11 compared SLR with SBRT. Our results showed that SLR, compared with either type of RT, significantly improved the overall survival regardless in both PSM and non-PSM analyses (all p<0.05). However, the pattern of failure after SLR was similar to that after SBRT (all p>0.05). In addition, RT and SLR were associated with specific complications. Conclusion These results demonstrated that SLR treatment of highrisk elderly patients with stage I NSCLC resulted in better overall survival compared with RT, including CFRT and SBRT. Considering the strength of the evidence, additional randomized controlled trials are needed before each treatment modality can be recommended routinely. EP-1202 A lot to a little or a little to a lot - dosevolume relationships in thoracic tumors C. Schröder1, R. Engenhart-Cabillic2, A. Buchali3 1 Universität Giessen, Klinik für Strahlentherapie und Radioonkologie- Universitätsklinikum Giessen und Marburg, Giessen, Germany 2 Universität Marburg, Marburg, Germany 3 Ruppiner Kliniken GmbH, Klinik für Strahlentherapie und Radioonkologie, Neuruppin, Germany Purpose or Objective The purpose of this prospective randomized trial was to determine which constellation of dose and corresponding volume of the lung tissue as seen in the dose-volumehistogram (DVH) - either a lot to a little or a little to a lot - should be preferred to ensure the best possible outcome for patients with thoracic carcinomas. To ensure a wider approach we focused on both objective and subjective parameters like clinical outcome, changes in pulmonary function tests (PFT), radiological changes and quality of life (QoL). Material and Methods From 04/12 to 10/15 81 patients with NSCLC, SCLC or esophageal carcinoma were randomized and treated with either a 4-field-IMRT (Arm A) or a VMAT (Arm B) technique.
Material and Methods Between June 2010 and March 2016, 25 patients with locally advanced breast cancer, who underwent modified radical mastectomy, IR, and PMRT were treated at our center. RT was delivered to the chest wall ± nodal areas according to stage, with 6MV and total dose of 50 Gy in 25 fractions. Complications were scored following the CTCAE 4.0 criteria. The capsular contracture was evaluated following the Baker classification. Cosmesis was rated as either acceptable or unacceptable to the patient. Results The mean age was 46.7 years (range, 33-65). A total of 20 patients underwent tissue expander and 5 underwent implant (TE/I). Median follow-up (from the start of RT) for all patients was 18 months (m) (4-48m). 40% of the patients were never smokers; 28% were smokers and 32% ex-smokers during RT. 10% and 68% of the patients received neoadjuvant and adjuvant chemotherapy respectively, and 17 patients taking Tamoxifen during RT. After surgery the complications occurred in 15/25 patients: 7 with capsulitis grade (G) 2; 2 with capsulitis G3-4; 3 with cutaneous suffering and mastitis, extrusion and hematoma were presented in 1 patient each. Complications post surgery in 2 patients as were hematoma and extrusion required additional surgery and delayed beginning of RT. All patients completed the RT course without major complications. During RT the only complication presented was skin erythema (SE) G1-2 seen in 20 (80%) and G3 in just 5 patients which were all smokers. During the follow up the major complications were: capsulitis G3 in 5 patients and G4 in 1; skin hyperpigmentation was presented in 4 patients, cutaneous thinning in 6 and 1 patient presented relevant lung toxicity. At the end of the follow-up, TE Exchange have been realized in 12 patients with a mean time after RT of 14,3m (9-22), 3 of them are pending of a new corrective surgery, specialy for improve cosmetic outcomes. We reported capsulitas G4 in 2 patients after the Exchange; both were smokers and 1 of them presented extrusion before RT, therefore she was operated twice. Acceptable cosmesis was reported in 60% of the patients Conclusion Our experiences is limited but in our patients undergoing PMRT, RT can be safely delivered after IR, with a low complication rate and good patient satisfaction. In our patients major complications occurred before RT. Further studies are needed to define the factors that may be related to worse aesthetic results. EP-1198 Low risk breast cancer patients' supportive care needs and perceptions of follow-up care options J. Kwan1, J. Croke1, J. Bender2, T. Panzarella1, K. Ubhi1, F. Liu1, A. Fyles1, A. Koch1, R. Dinniwell1, W. Levin1, D. McCready3, C. Chung1 1 Princess Margaret Cancer Centre- University Health Network/ University of Toronto, Radiation Oncology, Toronto, Canada 2 University Health Network, ELLICSR Cancer Survivorship Centre, Toronto, Canada 3 Princess Margaret Cancer Centre- University Health Network/ University of Toronto, Surgical Oncology, Toronto, Canada Purpose or Objective Breast cancer is the most common cancer in women and survival following treatment is rising. Although traditional follow-up care has been by oncology specialists posttreatment, literature over the last decade has shown that non-specialist follow-up care is a safe alternative for early-stage breast cancer patients. Barriers in transitioning patients from oncologist follow-up have not been well characterized. This study aims to assess i) the existing follow-up practices at a large institution, ii) met
and unmet supportive care needs, and iii) patient views on alternative care models, particularly involving primary care and eHealth. Material and Methods A cross-sectional survey of well breast cancer patients attending radiation oncology follow-up appointments from August 2012 to May 2013 at the Princess Margaret Cancer Centre (Toronto, Canada) was completed. Eligibility criteria included English-speaking patients with T2 or lower tumor stage, node negative status, and ER/PRpositive breast cancer treated with radiation. Four domains were assessed: health care service use, supportive care needs, perceptions of follow-up care options, and internet usage. Descriptive statistics were completed for all variables and univariable analyses were performed to examine relationships between key variables and domains. Results Response rate was 80% (191/259). Respondents had a mean age of 60 (SD=10.6). Median time since first followup was 21 months. The majority of respondents (161/191; 84%) received follow-up care from greater than one cancer specialist and had a median of 3 health care professional visits per year. The most preferred follow-up model was specialist care at a tertiary centre (178/191; 93%) and the least preferred models were specialist care through video conferencing (29/191; 15%) and email (28/191; 15%). Shared care models involving a specialist and family physician were modestly accepted (103/191; 54%). Primary care only follow-up was not well accepted (35/191; 18%), particularly among patients with higher education. Respondents who reported few unmet supportive care needs (p=0.01) or who search online for health information (p=0.02) were more likely to report perceived satisfaction with specialist follow-up via eHealth. Conclusion Specialist health care services continue to be utilized by early-stage breast cancer patients during the posttreatment period. Transitioning patients to alternative follow-up models may be difficult due to strong patient preference for specialist care. Based on this survey, a minority of patients are willing to accept shared care with family physicians or eHealth follow-up via videoconferencing or email at this time. Electronic Poster: Clinical track: Lung EP-1199 Radiotherapy for pN2 EGFR wide type adenocarcinoma & Squamous Cell Carcinoma lung cancer S.Y. Wu1 1 Taipei Medical University Hospital, No.111- Section 3 Department of Radiation Oncology, Taipei, Chinese Taipei Purpose or Objective There is a lack of large, prospective, randomized studies comparing postoperative radiotherapy (PORT) in pathological N2 (pN2) and surgical resection alone in terms of long-term survival in the setting of lung adenocarcinoma (adenoCA; wild-type [WT] epidermal growth factor receptor [EGFR]) and squamous cell carcinoma (squCA). This national cohort study clarifies the role of PORT in the survival of pN2 lung adenoCA (WT EGFR) and squCA. Material and Methods We analyzed data of patients with adenoCA (WT EGFR) and squCA collected from the Taiwan Cancer Registry database. The patients were categorized into five groups according to the treatment modality: Group 1, comprising
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those undergoing surgery alone; Group 2, comprising those undergoing adjuvant chemotherapy (CT) alone; Group 3, comprising those undergoing adjuvant radiotherapy (RT) alone; Group 4, comprising those receiving adjuvant concurrent chemoradiotherapy; and Group 5, comprising those receiving adjuvant sequential CT and intensity modulation RT. Results We enrolled 588 lung adenoCA (WT EGFR) and squCA patients without distant metastasis. After adjustments for age at surgery, surgical years, and Charlson comorbidity index scores, the multivariate Cox regression analysis demonstrated that adjusted HRs (aHRs; 95% confidence intervals [CIs]) for the overall mortality of female lung adenoCA (WT EGFR) patients were 0.257 (0.111–0.594), 0.530 (0.226–1.243), 0.192 (0.069–0.534), and 0.399 (0.172–0.928) in Groups 2, 3, 4, and 5, respectively. For male lung squCA patients, the aHRs (95% CIs) for overall mortality were 0.269 (0.160–0.451), 0.802 (0.458–1.327), 0.597 (0.358–0.998), and 0.456 (0.265–0.783) in Groups 2, 3, 4, and 5, respectively. Conclusion Adjuvant CCRT or sequential CT and IMRT ≥5000 cGy significantly reduced the mortality rate of female lung adenoCA (WT EGFR) and male squCA pN2 patients. EP-1200 Early versus late PORT for pathologic stage IIIA-N2 NSCLC: a multi-institutional retrospective study M.B. Meng1, H.H. Wang1, L. Deng2, Q.L. Wen3, C.Z. Zhang4, X.L. Zeng1, Y.L. Cui5, Z.Y. Yuan1, P. Wang1 1 Tianjin Medical University Cancer Institute & Hospital, Department of Radiation Oncology, tianjin, China 2 West China Hospital- West China of Medical SchoolSichuan University, Department of Thoracic Cancer, Chengdu, China 3 Affiliated Hospital of Southwest Medical University, Department of Oncology, Luzhou, China 4 Nankai University Tianjin People’s Hospital, Department of Surgery, Tianjin, China 5 Tianjin Medical University Cancer Institute & Hospital, Department of Lymphoma, tianjin, China Purpose or Objective The aim of this study was to evaluate the effect of the time of postoperative radiotherapy (PORT) in combined modality treatment for pathologic stage IIIA-N2 non-small cell lung cancer (NSCLC). Material and Methods Between January 2008 and December 2015, patients with pathologic stage IIIA-N2 NSCLC were enrolled and treated with PORT concurrent with or sequential to fewer than three cycles of postoperative chemotherapy (POCT, early PORT) or with PORT administered after at least four cycles of POCT (late PORT) at multiple hospitals. The primary end point was overall survival (OS); secondary end points included pattern of the first failure, locoregional recurrence-free survival (LRRFS), and distant metastasisfree survival (DMFS). Kaplan–Meier OS, LRRFS, and DMFS curves were compared with the log-rank test. Cox regression analysis was used to determine prognosticators for OS, LRRFS, and DMFS. Results Of 112 included patients, 41 (36.61%) and 71 (63.39%) patients received early PORT and late PORT, respectively. The median OS, LRRFS, and DMFS were longer for those who received early PORT than for those who received late PORT at the median follow-up of 29.6 months (all p < 0.05). Uni- and multi-variate analyses showed that number of POCT cycles and the combination schedule of PORT and POCT were independent prognostic factors for OS, LRRFS, and DMFS.
Conclusion Pathologic stage IIIA-N2 NSCLC patients treated with early PORT experienced better OS, LRRFS, and DMFS than those treated with late PORT. Thus, early PORT should be considered as a primary approach for those patients. EP-1201 SLR versus SBRT for high-risk elderly patients with stage I NSCLC H.H. Wang1, M.B. Meng1, X.L. Zeng1, L. Deng2 1 Tianjin Medical University Cancer Institute & Hospital, Department of Radiation Oncology, , China 2 West China Hospital- West China School of MedicineSichuan University, Department of Thoracic Cancer, Tanjin, China Purpose or Objective The purpose of this study was to evaluate the efficacy and safety of radiotherapy (RT) for high-risk elderly patients with stage I non-small cell lung cancer (NSCLC) through a meta-analysis of data from published studies comparing sublobar resection (SLR) with RT including conventional fraction radiation therapy (CFRT) and stereotactic body radiation therapy (SBRT). Material and Methods We searched the Cochrane Library, MEDLINE, CENTRAL, and EMBASE and conducted manual searches. Metaanalysis was performed on the results of homogeneous studies. Analyses subdivided by study design were also performed. Results Based on our search criteria, we found 16 trials involving 11540 patients. Nine were propensity-score matched (PSM) cohort studies, and 7 were cohort studies. Five studies compared SLR with CFRT, and 11 compared SLR with SBRT. Our results showed that SLR, compared with either type of RT, significantly improved the overall survival regardless in both PSM and non-PSM analyses (all p<0.05). However, the pattern of failure after SLR was similar to that after SBRT (all p>0.05). In addition, RT and SLR were associated with specific complications. Conclusion These results demonstrated that SLR treatment of highrisk elderly patients with stage I NSCLC resulted in better overall survival compared with RT, including CFRT and SBRT. Considering the strength of the evidence, additional randomized controlled trials are needed before each treatment modality can be recommended routinely. EP-1202 A lot to a little or a little to a lot - dosevolume relationships in thoracic tumors C. Schröder1, R. Engenhart-Cabillic2, A. Buchali3 1 Universität Giessen, Klinik für Strahlentherapie und Radioonkologie- Universitätsklinikum Giessen und Marburg, Giessen, Germany 2 Universität Marburg, Marburg, Germany 3 Ruppiner Kliniken GmbH, Klinik für Strahlentherapie und Radioonkologie, Neuruppin, Germany Purpose or Objective The purpose of this prospective randomized trial was to determine which constellation of dose and corresponding volume of the lung tissue as seen in the dose-volumehistogram (DVH) - either a lot to a little or a little to a lot - should be preferred to ensure the best possible outcome for patients with thoracic carcinomas. To ensure a wider approach we focused on both objective and subjective parameters like clinical outcome, changes in pulmonary function tests (PFT), radiological changes and quality of life (QoL). Material and Methods From 04/12 to 10/15 81 patients with NSCLC, SCLC or esophageal carcinoma were randomized and treated with either a 4-field-IMRT (Arm A) or a VMAT (Arm B) technique.