EP-1218 GLUTAMINE TREATMENT TO PREVENT LATE ESOPHAGITIS IN LUNG CANCER PATIENTS TREATED WITH RADIOCHEMOTHERAPY

S468

with advanced chemotherapy.

ESTRO 31

non-small

cell

lung

cancer

after

induction

EP-1218 GLUTAMINE TREATMENT TO PREVENT LATE ESOPHAGITIS IN LUNG CANCER PATIENTS TREATED WITH RADIOCHEMOTHERAPY J. Luna Tirado1, T. Iglesias1, J. Olivera1, J. Vara1, I. Prieto1, A. Chavez1, A. Alvarado2, J. Pardo2, A. Mena3, A. Perez1 1 CAPIO-Fundación Jimenez Díaz, Radiation Oncology Department, Madrid, Spain 2 CAPIO- Catalunya General Hospital, Radiation Oncology Department, Barcelona, Spain 3 Hospital Universitari Son Espases, Radiation Oncology Department, Palma de Mallorca, Spain Purpose/Objective: To study the incidence and severity of late esophagitis, determine the relationship between acute and late esophagitis in lung cancer patients (pts) treated with radiochemotherapy (CHRT) and assess the efficacy of glutamine in preventing its presentation. Materials and Methods: From January 2008 to May 2010, 36 pts diagnosed with lung cancer treated with CHRT with radical intent were included. Age: Mean 61 years (range 45-84).14 pts had limited disease small cell carcinoma (41.2%) and 20 non-small cell carcinoma (58.8%). All pts received three-dimensional conformal radiotherapy (3D-EBRT). Total dose: 60 Gy, 2 Gy/fr, 5 fr/week (80% concomitant chemotherapy, 20% sequentially), and received daily treatment with glutamine (10 gr./8h) from five days before the start of 3D-EBRT until 15 days after its completion. Afterwards follow-up evaluations were performed. Late esophagitis was scored by the RTOG late toxicity grading scale, and its relationship with V50 in the DVH's as the best predictor of late esophagitis. The median follow-up time was 11 months. Results: 88.9% of the pts (32) had not presented any late esophagitis. Of these, 34,7% (11) had no acute esophagitis during 3D-EBRT, 46.8% (15) had grade I esophagitis, 15.6% (5) grade II and 3.1% (1) grade III. The remaining 4 pts (11.1%) presented grade I late esophagitis. Of these 50% had no acute esophagitis during 3D-EBRT and 50% had grade III esophagitis. Considering the value of V50, in the group of 23 patients with V50 <30%, 95.7% did not presented late esophagitis and 4.3% presented grade I. The group of 11 patients with V50> 30%, 72.7% did not presented late esophagitis and 27.3% presented grade I. Nor grade II or Grade III late toxicities were recorded. Conclusions: The recruitment of pts continues. Although its number and follow-up time are short, our preliminary results indicate that the incidence of late esophagitis is very low without any case of severity. Glutamine treatment may be beneficial in preventing its development. V50 <30% is a good predictive parameter of developing late esophagitis secondary to CHRT. A longer follow-up and more recruitment are needed to confirm these preliminary data. EP-1219 HYPOFRACTIONATED RADIATION THERAPY OF PERIPHERAL NON-SMALL CELL LUNG CANCER. FIVE YEARS RESULTS M. Ilin1, V. Sotnikov1, G. Panshin2, V. Solodky3 1 Russian Scientific Center of Roentgenoradiology, Combined treatment methods, Moscow, Russian Federation 2 Russian Scientific Center of Roentgenoradiology, Radiation therapy, Moscow, Russian Federation 3 Russian Scientific Center of Roentgenoradiology, Director, Moscow, Russian Federation Purpose/Objective: The aim of this study was to evaluate the longterm results of radiation therapy of peripheral non-small cell lung cancer (NSCLC) with escalation of daily dose (3-4Gy) and the total dose (TD) of 60Gy. Materials and Methods: Between January 2003 and June 2011 we treated 63 patients at the age of 45-82 years (median - 70) with medically inoperable peripheral NSCLC (stage IA-7, stage IB-15, IIB-11, IIIA-12, IIIB-10, stage IV -8 patients). All cases were morphologically proven (epydermoid cancer – 28, adenocarcinoma – 25, others – 10). 18 patients received 2-4 cycles of neoadjuvant chemotherapy with a minor effect. The group of 48 patients was irradiated on Cobalt 60 gamma units and another 15 patients - on linear accelerators (618Mev), both of them after the CT-based 2-D or 3-D planning. The daily dose of 3-4Gy (specified at 90% isodose) was given 5 times a week. The TD for the tumor was 60Gy (α/β=3, EQD2=72-84Gy), the TD for the involved lymph nodes was 39Gy (EQD2=47Gy). Mean follow-up period was 24,7 months (4 - 68 months).

Results: The irradiation was interrupted (7-9 days) due to esophagitis grade I in 14 cases with mediastinal lymph nodes involvement. According to RESIST criteria, the complete regression of the tumor after the radiation therapy was achieved in 13 patients (20,6%), the partial regression in 29 patients (45,1%) and the stabilization in 21 patients (33,3%). Pulmonitis grade II was diagnosed only in 10 patients (16,0%) during the next 3 months after the radiation therapy and has resolved successfully in all cases. Local changes of lung tissue density were revealed by CT in 62 patients and were more severe in nonsmoking patients. No patients experienced shot-term or long-term toxicity grade III-IV according to RTOG criteria. Actuarial survival without infield progression for all group was demonstrated as followed: 1 year – 87,2±4,5%, 5 years – 60,6±10,2% (T1-2: 1 year 95,3±3,3%, 5 years - 63,4±12,8%; T3-4: 1 year – 60,0±13,9%, 5 years – 21,1±15,5%). Disease-specific survival for all group was shown for 1 year - 87,6±4,3%, 5 years – 35,3±8,5% (stage IA,IB – 95,2±4,6% and 43,3±14,0%, stage IIB-IV - 83,1±6,3% and 21,5±10,3%) and the overall survival for all group was for 1 year – 76,7±5,5%, 5 years – 24,2±7,0% (stage IA,IB - 86,4±7,3% and 32,0±12,6%, stage IIB-IV - 71,1±7,4% and 16,3±8,0% respectively). Conclusions: The local control of peripheral NSCLC could be successfully achieved after hypofractionated radiation therapy with daily dose 3-4Gy (TD 60Gy) in more than a half of the patients. Even the patients with locally advanced disease have the real chance to survive 5 years and more if treated according to our protocol. The SBRT is the method of choice for the patients with the high comorbidity and with early lung cancer still, but the hypofractionated radiation therapy with escalation of isoeffective TD could be used as the potentially curative treatment in the cases of more advanced peripheral NSCLC. EP-1220 PRONOSTIC AND PREDICTIVE FACTORS IN LOCALLY ADVANCED LUNG CANCER STAGE III TREATED BY CHEMO-RADIATION K. Boudaoud1, S. Taleb1, A. Brihmat1, T. Filali2, A. Djemaa1 1 CHU Benbadis, Oncology-Radiotherapy, Constantine, Algeria 2 CHU Benbadis, Medical Oncology, Constantine, Algeria Purpose/Objective: Concurrent chemoradiotherapy (CCRT) is the standard treatment for unresectable locally advanced non small cell lung cancer ( NSCLC), Several chemotherapies with platinum were jointly associated with the radiotherapy however, oesophagitis still remains one of the major toxicities.The aim of this work is to analyse the impact of prognostic factors on disease-free survival (DFS) and overall survival (OS) in patients affected by NSCLC stage III treated with combined therapy. Materials and Methods: Between December 2005, and January 2009, a total of 120 patients with pathologically proven locally advanced NSCLC stage III (IIIA, 42; IIIB, 78) were treated with CCRT in our department (8 women, 112 men), their ages ranging from 44 to 65 years (median, 54,5 years) and with a good Karnofsky Performance Status (KPS) ≥80 (KPS >80 to 56 patients, KPS=80 to 64 patients). 92% of our patients were smokers. The cough, which dominated the clinical symptomatology, was found in 89% of cases. 104 patients were presented a loss of weight which is > 5 kg in the 6months which preceded the disease; the histological chap was dominated by the squamous cell carcinoma in (65 %) of cases. Conventional Radiation therapy was delivered by cobalt 60 (the total dose for the primary lung tumor and mediastinal lymph nodes was 65 Gy,with daily fractionation of 1.8 Gy/die, for 7weeks), with association of chemotherapy, the treatment schedule consisted of Cisplatin (45 mg/m2) on days 1, 2 and Etoposide 80mg/m2 on days 1, 2, 3; chemotherapy was given every 21days, for three courses. Results: The 1and 2 years Overall survival rats were respectively (63%, 35%-), with a median survival time of 16 months,the 2 year diseasefree survival rats was 25%. Univariate and multivariate analysis demonstrated that the performance status and the stage of disease were statistically significant predictors of OS and DFS (KPS :p= 0.00001), (stage IIIA versus IIIB : Os ;p=0,0189 and DFS p=0,0128).The œsophagitis grade 2-3 is 25 % respectively (22 %, 3 %), pneumonitis grade 3-4 is found in 5 % of the cases. The average period of appearance of the local and distant recurrences is of 13 months the brain metastases represent 30 % of cases. Conclusions: Concurrent chemo-radiation therapy improves the survival of the locally advanced NSCLC, however, oesophagitis is a major toxicity and this therapeutic modality should be reserved for patients with good performance status. The new technologies in radiotherapy, dose escalation and the association with the targeted