- Email: [email protected]
Hypofractionated Stereotactic Radiation Therapy for Large and Central Lung Tumors
Volume 84 Number 3S Supplement 2012 and gross pathologic tumor size (rZ0.916, p<.001). A total of 4 patients (19%), all ACA, had a pathologic complete response (pCR). Of the 16 patients without pCR, 11 (69%) had viable tumor present at the interface between tumor and benign lung parenchyma and 8 of these patients (73%) showed histologic features of viable tumor cell invasion into surrounding normal lung parenchyma. No independent patient or treatment variable predicted for the presence of tumor at the interface or invasion into lung parenchyma. Conclusions: Despite evidence of radiologic tumor regression, most patients treated with chemoRT for advanced NSCLC have viable tumor cells present at the interface between treatment effect and benign lung. Most of these patients also had evidence of microscopic tumor invasion into surrounding lung parenchyma. Our results should promote an increased awareness of PTV margins especially when adaptive radiation therapy techniques using field size reduction are utilized. Author Disclosure: M.C. Stauder: None. A.C. Roden: None. D. Wigle: None. K.A. Price: None. Y.I. Garces: None. K.R. Olivier: None.
2881 Feasibility of Hypofractionated Radiation Therapy (RT) for End-oflife Palliation: Preliminary Results From a Prospective Randomized Study A. Mohamed, N.A. Eldeeb, A.M. Belal, and A. Ganady; Faculty of Medicine, University of Alexandria, Alexandria, Egypt Purpose/Objective(s): Extended palliative RT for patients at the end-oflife may be logistically and economically expensive, with limited/minimal expected survival gain. To this end, we investigated the feasibility of a hypofractionated palliative RT regimen in poor performance status (PS) patients with inoperable, symptomatic, locally advanced/metastatic NSCLC. Materials/Methods: A total of 30 patients with 6 month-life expectancy, PS 2 and symptomatic stage III or stage IV NSCLC, seen from June 2008 till July 2009, were enrolled. Patients were randomly assigned to two groups: A (15 pts) received 30 Gy in 10 fractions and B (15 pts) 17 Gy in 2 fractions separated by one week. The primary end point of the study was the control of the intrathoracic symptoms as measured, by patients’ self-reported symptom control using the EORTC lung cancer-specific module (LC13) as well as clinicians’ reported assessment using the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0, at base line, 1, 6 and 16 weeks after the end of radiation therapy. Secondary endpoints were: acute toxicity profile, overall Quality of Life QOL using EORTC QLQ-C30, tumor control and survival. Results: The patients’ major clinical characteristics and incidence/ degree of initial disease-related symptoms were homogenous between both study groups (p > 0.05). Significant improvement in the mean scores of airway symptoms (p < 0.05) was achieved equally in both arms as reported by patients using LC13. Hemoptysis had the highest improvement rate in 100% of patients in both groups followed by chest pain, cough, and dyspnea with improvement rates ranging from 60-73.3%. According to clinicians’ symptom assessment, improvement of symptoms meant a 1 step decrease in Symptom’s grade. Hemoptysis again had the highest improvement rate of 100% in both groups followed by chest pain, dyspnea, and cough with improvement rates ranging from 60-71.4%. Treatment was well tolerated in both groups. Dysphasia was considered the main side effect with RTOG grade 3 toxicity seen in one patient (6.7%), and in 2 patients (13.3%) of group A and B, respectively. No other RTOG toxicities of grades 3 were noted. Quality of life was preserved equally in both groups with no significant differences in the mean scores of QLQ-30 (all p >0.05) at any time point. No significant difference in the overall survival was seen, with median survival of 5 and 6 months in group A and B, respectively (KM pZ 0.55). Conclusions: The explored hypofractionated regimen was feasible, less expensive, and more convenient for patients with symptomatic advanced
Poster Viewing Abstracts S549 disease and limited expected survival versus the standard regimen. It also proved to be equally effective in terms of palliative effect, treatment tolerance, quality of life, and overall survival. Author Disclosure: A. Mohamed: None. N.A. Eldeeb: None. A.M. Belal: None. A. Ganady: None.
2882 Predicting Symptomatic Radiation Pneumonitis After Concurrent Chemoradiation Therapy for Non-small Cell Lung Cancer: Results of an International Individual Patient Data Meta-analysis D.A. Palma,1 S. Senan,2 K. Tsujino,3 R.B. Barriger,4 R. Rengan,5 M. Moreno,6 J.D. Bradley,7 T. Hyun Kim,8 L.B. Marks,9 G. Rodrigues,1et al.; 1London Regional Cancer Program, London, ON, Canada, 2VU University Medical Center, Amsterdam, Netherlands, 3Hyogo Cancer Center, Hyogo, Japan, 4Indiana University School of Medicine, Indianapolis, IN, 5University of Pennsylvania, Philadelphia, PA, 6Clı´nica Universidad de Navarra, Pamplona, Spain, 7 Washington University School of Medicine, St. Louis, MO, 8National Cancer Center, Goyang, Korea, Democratic People’s Republic of, 9 University of North Carolina, Chapel Hill, NC Purpose/Objective(s): Radiation pneumonitis is a dose-limiting toxicity for patients undergoing concurrent chemoradiation therapy (CCRT) for non-small cell lung cancer (NSCLC). We performed an individual patient data meta-analysis to determine factors predictive of clinically significant pneumonitis. Materials/Methods: After a systematic review of the literature, data was obtained on 836 patients who underwent CCRT in Europe, North America and Asia. Patients were randomly divided into training and validation sets (2/3 vs. 1/3 of patients). Factors predictive of symptomatic or fatal pneumonitis were evaluated using logistic regression. Recursive partitioning analysis (RPA) was used to define risk groups. Results: The median radiation therapy dose was 60 Gy, and median follow-up was 2.3 years. Most patients received concurrent cisplatin/ etoposide (38%) or carboplatin/paclitaxel (26%). The overall rate of symptomatic pneumonitis was 29.8% (nZ249), with fatal pneumonitis in 1.9% (nZ16). In the training set, factors predictive of symptomatic pneumonitis were lung volume receiving 20 Gy (V20) [OR:1.03 per 1% increase, pZ0.008], and carboplatin/paclitaxel chemotherapy [OR:3.33, p0.65). On RPA, the highest risk of pneumonitis (>50%) was in patients >65 years of age receiving carboplatin/paclitaxel. Predictors of fatal pneumonitis were daily dose >2 Gy, V20, and lower-lobe tumor location. Conclusions: Several modifiable risk factors predict the development of symptomatic pneumonitis, and elderly patients who undergo CCRT with carboplatin-paclitaxel chemotherapy are at highest risk. Fatal pneumonitis, although uncommon, is related to dosimetric factors and tumor location. Funding: Ontario Institute for Cancer Research (DP) and in part by National Institutes of Health Grant CA69579 (LBM) Author Disclosure: D.A. Palma: None. S. Senan: E. Research Grant; Sanofi Aventis. K. Tsujino: None. R.B. Barriger: None. R. Rengan: None. M. Moreno: None. J.D. Bradley: None. T. Hyun Kim: None. L.B. Marks: None. G. Rodrigues: None.
2883 Hypofractionated Stereotactic Radiation Therapy for Large and Central Lung Tumors E. Bongers, M.R. Dahele, C.J. Haasbeek, P.F. de Haan, W.F. Verbakel, B.J. Slotman, and S. Senan; VU University Medical Center, Amsterdam, Netherlands Purpose/Objective(s): High local control rates have been reported for central lung tumors treated using stereotactic radiation therapy (SABR) delivered using 8 fractions of 7.5 Gy. More centrally located tumors (e.g. PTV overlapping esophagus or carina), and PTVs >200 cc were previously
S550
International Journal of Radiation Oncology Biology Physics
not considered suitable. We introduced a risk-adapted scheme delivering 60 Gy in 12 fractions, with under-dosing of PTV accepted in order to meet organ at risk (OAR) constraints. We report early outcomes with this approach. Materials/Methods: Between 2009 and 2011, 49 patients (50 PTVs) were treated with the 12 x 5 Gy scheme (4 fractions/week) prescribed to 95% of the PTV (maximum dose 140%). Forty-three patients (88%) were treated for lung cancer (32 N0, 8 N1, 3 N2-3), 2 (4%) for nodal recurrence (N2-3) and 4 (8%) for metastatic disease. After multidisciplinary evaluation, the reasons for not receiving standard surgery or chemoradiation therapy included comorbidity (53%), metastases (14%), prior pneumectomy or bilobectomy (12%), bilateral tumors (8%) and patient refusal (8%). 4DCT planning was performed with 5mm ITV-PTV margins, VMAT, and online CBCT tumor setup. Esophageal and brachial plexus dose were limited to a point Dmax of 48 Gy and 42 Gy, respectively. Overlap of PTV with central airways was accepted. Patients underwent post-treatment follow-up visits and CT scans at 3, 6, 12 and 24 months post-SABR. Toxicity was scored using CTCAE v4.03. Results: The median follow-up was 6.8 months (0.7-22.2). Median PTV volume was 105cc (10 - 411cc). PTV was <1cm from the esophagus in 45% of plans, overlapped trachea, carina or main bronchi in 57%, and exceeded 200 cc in 22%. The target prescription of 60Gy was achieved in 46 PTVs. An under-dosage of 4 PTVs (60 Gy delivered to 90.494.6% of the PTV) was required in order to meet dose constraints for esophagus (3 patients) and brachial plexus (1 patient). The mean dose in the PTV was 65.0 - 74.9Gy (median 68.2 Gy). Grade 3 toxicity was recorded in 12%. Five patients (10%) developed grade 3 radiation pneumonitis (RP) and one had chest wall pain. One grade 5 fatal lung hemorrhage was identified and treatment-related deaths could not be ruled out in 3 other cases (hemorrhage in a patient with local recurrence, progressive disease with possible pulmonary infection, and grade 3 RP plus septicemia due to urinary tract infection). Estimated overall survival and local control rates were 95.5% and 100% at 6 months and 71.5% and 91.8% at 12 months. Updated follow-up will be available in October 2012. Conclusions: This risk-adapted hypofractionated stereotactic delivery scheme of 60Gy in 12 fractions is a feasible option in large and/or central lung tumors, in patients not fit to undergo standard chemoradiation therapy or surgery. Early experience suggests that toxicity is acceptable but longer follow-up is needed to better evaluate tumor control and therapeutic ratio. Author Disclosure: E. Bongers: J. Funding Other; Department has a Research Agreement with Varian Medical Systems. M.R. Dahele: F. Honoraria; Varian Medical Systems. H. Travel Expenses; Varian Medical Systems, Brainlab. C.J. Haasbeek: None. P.F. de Haan: None. W.F. Verbakel: H. Travel Expenses; Varian Medical Systems. B.J. Slotman: H. Travel Expenses; Varian Medical Systems. J. Funding Other; Speaker Fee Varian Medical Systems. S. Senan: F. Honoraria; Varian Medical Systems. H. Travel Expenses; Varian Medical Systems.
Results: The complete response (CR) was 1 patient; the partial response (PR) was 31 patients. The overall tumor response (CR+PR) rate was 96.97% (32/33). The 1-,2- year survival rates were respectively 68.2%, 43.0%. The 1-,2- year local control rates were respectively 95.8%, 72.8%. The acute pneumonitis and esophagitis incidence rates were 36.36% and 33.33% respectively. No grade III/IV radiation pneumonitis or esophagitis was observed. The leukocytopenia rate was 39.39%, and there was 1 case of grade III. Conclusion: The SIB-CR technique for non-small cell lung cancer was feasible and with a higher tumor response. Radiation toxicities can be well tolerated. The late toxicities and long-term survival need to be observed. Author Disclosure: X. Qiao: None. J. Li: None. Y. Song: None. Z. Zhou: None. C. Zhen: None.
2884 Prospective Study of Simultaneous Integrated Boost Conformal Radiation Therapy in Locally Advanced Central Non-small Cell Lung Cancer X. Qiao, J. Li, Y. Song, Z. Zhou, and C. Zhen; Fourth Hospital, Hebei Medical University, Shijiazhuang, China Purpose/Objective(s): To evaluate the feasibility of simultaneous integrated boost conformal radiation therapy (SIB-CR) in patients with locally advanced central non-small cell lung cancer (LANSCLC). Materials/Methods: Thirty-three patients with LANSCLC treated with SIB-CR planning between December 2007 and July 2011. Simultaneous integrated boost conformal radiation therapy (SIB-CR) was used. The prescribed dose of PTV was 5040cGy/28fractions and GTV was given to 6440cGy/28fractions simultaneously. The total treatment time was about 5.5 weeks (1 time a day, 5 fractions a week).
2885 Involved-Field Radiation Therapy Using Protons or Carbon Ions for N1-2M0 Non-small Cell Lung Cancer: A Retrospective Study O. Fujii,1 N. Hashimoto,1 K. Terashima,1 M. Mima,1 Y. Demizu,1 Y. Niwa,1 R. Sasaki,2 Y. Hishikawa,1 M. Abe,1 and M. Murakami1; 1Hyogo Ion Beam Medical Center, Tatsuno, Japan, 2Kobe University Graduate School of Medicine, Kobe, Japan Purpose/Objective(s): Limited clinical data exists in the use of involved-field radiation therapy (IFRT) for node-positive lung cancer. The purpose of this study was to analyze the results of IFRT using protons or carbon ions for N1-2M0 non-small cell lung cancer (NSCLC) retrospectively. Materials/Methods: Between April 2003 and March 2011, a total of 45 patients with N1-2M0 NSCLC received proton or carbon ion radiation therapy. Among these patients, 9 patients were excluded from this study because eight were lost to follow-up and one had previously received irradiation to the recurrent site. The remaining 36 patients were identified and retrospectively analyzed. Twenty-nine patients were male and 7 were female. Median age was 76 years (range, 50-90). Eighteen patients had squamous carcinoma, 12 had adenocarcinoma and 6 had others. Thirtythree patients were medically inoperable and 3 refused surgery. The lung cancer was staged as T1N1M0, 3; T1N2M0, 3; T2N1M0, 9; T3N1M0, 2; T4N1M0, 7; T4N2M0, 5; rN1, 5; and rN2, 2. Twenty patients were treated with proton therapy of 65-80 GyE/10-40 fractions and 16 patients with carbon ion therapy of 57.6-70.2 GyE/10-26 fractions. Survival and local control were evaluated using the Kaplan-Meier method. Acute and late morbidities were assessed based on the Common Terminology Criteria for Adverse Events (CTCAE) v3.0. The median follow-up time was 16 months (range, 5-89 months). Results: The actuarial 2-year rates of overall survival, progression-free survival, local control and elective nodal control were 64%, 52%, 77% and 93%, respectively. Local progression occurred in 6 patients (17%). Elective nodal and distant metastases were observed in 3 patients (8%) and 14 patients (39%), respectively. Grade3 acute reactions were observed in 4 patients (dermatitis in 3 and esophagitis in 1); however no patients discontinued the treatment. Grade3 and 4 late adverse events were observed in 6 patients (pneumonitis) and 1 (esophagotracheal fistula), respectively. Conclusions: This study showed that IFRT using protons or carbon ions for N1-2M0 NSCLC provided favorable outcome with acceptable toxicity, therefore serving as an effective treatment option especially for medically inoperable N1-2M0 NSCLC. More accumulation of patients and longer follow-up would be warranted. Author Disclosure: O. Fujii: None. N. Hashimoto: None. K. Terashima: None. M. Mima: None. Y. Demizu: None. Y. Niwa: None. R. Sasaki: None. Y. Hishikawa: None. M. Abe: None. M. Murakami: None.
2886 Stereotactic Body Radiation Therapy for Lung Cancer in Octogenarians T. Ishihara, K. Yamada, M. Tanahashi, H. Niwa, T. Matsui, K. Yokomura, and R. Sasaki; Seirei Mikatahara General Hospital, Hamamatsu, Japan
2881 Feasibility of Hypofractionated Radiation Therapy (RT) for End-oflife Palliation: Preliminary Results From a Prospective Randomized Study A. Mohamed, N.A. Eldeeb, A.M. Belal, and A. Ganady; Faculty of Medicine, University of Alexandria, Alexandria, Egypt Purpose/Objective(s): Extended palliative RT for patients at the end-oflife may be logistically and economically expensive, with limited/minimal expected survival gain. To this end, we investigated the feasibility of a hypofractionated palliative RT regimen in poor performance status (PS) patients with inoperable, symptomatic, locally advanced/metastatic NSCLC. Materials/Methods: A total of 30 patients with 6 month-life expectancy, PS 2 and symptomatic stage III or stage IV NSCLC, seen from June 2008 till July 2009, were enrolled. Patients were randomly assigned to two groups: A (15 pts) received 30 Gy in 10 fractions and B (15 pts) 17 Gy in 2 fractions separated by one week. The primary end point of the study was the control of the intrathoracic symptoms as measured, by patients’ self-reported symptom control using the EORTC lung cancer-specific module (LC13) as well as clinicians’ reported assessment using the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0, at base line, 1, 6 and 16 weeks after the end of radiation therapy. Secondary endpoints were: acute toxicity profile, overall Quality of Life QOL using EORTC QLQ-C30, tumor control and survival. Results: The patients’ major clinical characteristics and incidence/ degree of initial disease-related symptoms were homogenous between both study groups (p > 0.05). Significant improvement in the mean scores of airway symptoms (p < 0.05) was achieved equally in both arms as reported by patients using LC13. Hemoptysis had the highest improvement rate in 100% of patients in both groups followed by chest pain, cough, and dyspnea with improvement rates ranging from 60-73.3%. According to clinicians’ symptom assessment, improvement of symptoms meant a 1 step decrease in Symptom’s grade. Hemoptysis again had the highest improvement rate of 100% in both groups followed by chest pain, dyspnea, and cough with improvement rates ranging from 60-71.4%. Treatment was well tolerated in both groups. Dysphasia was considered the main side effect with RTOG grade 3 toxicity seen in one patient (6.7%), and in 2 patients (13.3%) of group A and B, respectively. No other RTOG toxicities of grades 3 were noted. Quality of life was preserved equally in both groups with no significant differences in the mean scores of QLQ-30 (all p >0.05) at any time point. No significant difference in the overall survival was seen, with median survival of 5 and 6 months in group A and B, respectively (KM pZ 0.55). Conclusions: The explored hypofractionated regimen was feasible, less expensive, and more convenient for patients with symptomatic advanced
Poster Viewing Abstracts S549 disease and limited expected survival versus the standard regimen. It also proved to be equally effective in terms of palliative effect, treatment tolerance, quality of life, and overall survival. Author Disclosure: A. Mohamed: None. N.A. Eldeeb: None. A.M. Belal: None. A. Ganady: None.
2882 Predicting Symptomatic Radiation Pneumonitis After Concurrent Chemoradiation Therapy for Non-small Cell Lung Cancer: Results of an International Individual Patient Data Meta-analysis D.A. Palma,1 S. Senan,2 K. Tsujino,3 R.B. Barriger,4 R. Rengan,5 M. Moreno,6 J.D. Bradley,7 T. Hyun Kim,8 L.B. Marks,9 G. Rodrigues,1et al.; 1London Regional Cancer Program, London, ON, Canada, 2VU University Medical Center, Amsterdam, Netherlands, 3Hyogo Cancer Center, Hyogo, Japan, 4Indiana University School of Medicine, Indianapolis, IN, 5University of Pennsylvania, Philadelphia, PA, 6Clı´nica Universidad de Navarra, Pamplona, Spain, 7 Washington University School of Medicine, St. Louis, MO, 8National Cancer Center, Goyang, Korea, Democratic People’s Republic of, 9 University of North Carolina, Chapel Hill, NC Purpose/Objective(s): Radiation pneumonitis is a dose-limiting toxicity for patients undergoing concurrent chemoradiation therapy (CCRT) for non-small cell lung cancer (NSCLC). We performed an individual patient data meta-analysis to determine factors predictive of clinically significant pneumonitis. Materials/Methods: After a systematic review of the literature, data was obtained on 836 patients who underwent CCRT in Europe, North America and Asia. Patients were randomly divided into training and validation sets (2/3 vs. 1/3 of patients). Factors predictive of symptomatic or fatal pneumonitis were evaluated using logistic regression. Recursive partitioning analysis (RPA) was used to define risk groups. Results: The median radiation therapy dose was 60 Gy, and median follow-up was 2.3 years. Most patients received concurrent cisplatin/ etoposide (38%) or carboplatin/paclitaxel (26%). The overall rate of symptomatic pneumonitis was 29.8% (nZ249), with fatal pneumonitis in 1.9% (nZ16). In the training set, factors predictive of symptomatic pneumonitis were lung volume receiving 20 Gy (V20) [OR:1.03 per 1% increase, pZ0.008], and carboplatin/paclitaxel chemotherapy [OR:3.33, p0.65). On RPA, the highest risk of pneumonitis (>50%) was in patients >65 years of age receiving carboplatin/paclitaxel. Predictors of fatal pneumonitis were daily dose >2 Gy, V20, and lower-lobe tumor location. Conclusions: Several modifiable risk factors predict the development of symptomatic pneumonitis, and elderly patients who undergo CCRT with carboplatin-paclitaxel chemotherapy are at highest risk. Fatal pneumonitis, although uncommon, is related to dosimetric factors and tumor location. Funding: Ontario Institute for Cancer Research (DP) and in part by National Institutes of Health Grant CA69579 (LBM) Author Disclosure: D.A. Palma: None. S. Senan: E. Research Grant; Sanofi Aventis. K. Tsujino: None. R.B. Barriger: None. R. Rengan: None. M. Moreno: None. J.D. Bradley: None. T. Hyun Kim: None. L.B. Marks: None. G. Rodrigues: None.
2883 Hypofractionated Stereotactic Radiation Therapy for Large and Central Lung Tumors E. Bongers, M.R. Dahele, C.J. Haasbeek, P.F. de Haan, W.F. Verbakel, B.J. Slotman, and S. Senan; VU University Medical Center, Amsterdam, Netherlands Purpose/Objective(s): High local control rates have been reported for central lung tumors treated using stereotactic radiation therapy (SABR) delivered using 8 fractions of 7.5 Gy. More centrally located tumors (e.g. PTV overlapping esophagus or carina), and PTVs >200 cc were previously
S550
International Journal of Radiation Oncology Biology Physics
not considered suitable. We introduced a risk-adapted scheme delivering 60 Gy in 12 fractions, with under-dosing of PTV accepted in order to meet organ at risk (OAR) constraints. We report early outcomes with this approach. Materials/Methods: Between 2009 and 2011, 49 patients (50 PTVs) were treated with the 12 x 5 Gy scheme (4 fractions/week) prescribed to 95% of the PTV (maximum dose 140%). Forty-three patients (88%) were treated for lung cancer (32 N0, 8 N1, 3 N2-3), 2 (4%) for nodal recurrence (N2-3) and 4 (8%) for metastatic disease. After multidisciplinary evaluation, the reasons for not receiving standard surgery or chemoradiation therapy included comorbidity (53%), metastases (14%), prior pneumectomy or bilobectomy (12%), bilateral tumors (8%) and patient refusal (8%). 4DCT planning was performed with 5mm ITV-PTV margins, VMAT, and online CBCT tumor setup. Esophageal and brachial plexus dose were limited to a point Dmax of 48 Gy and 42 Gy, respectively. Overlap of PTV with central airways was accepted. Patients underwent post-treatment follow-up visits and CT scans at 3, 6, 12 and 24 months post-SABR. Toxicity was scored using CTCAE v4.03. Results: The median follow-up was 6.8 months (0.7-22.2). Median PTV volume was 105cc (10 - 411cc). PTV was <1cm from the esophagus in 45% of plans, overlapped trachea, carina or main bronchi in 57%, and exceeded 200 cc in 22%. The target prescription of 60Gy was achieved in 46 PTVs. An under-dosage of 4 PTVs (60 Gy delivered to 90.494.6% of the PTV) was required in order to meet dose constraints for esophagus (3 patients) and brachial plexus (1 patient). The mean dose in the PTV was 65.0 - 74.9Gy (median 68.2 Gy). Grade 3 toxicity was recorded in 12%. Five patients (10%) developed grade 3 radiation pneumonitis (RP) and one had chest wall pain. One grade 5 fatal lung hemorrhage was identified and treatment-related deaths could not be ruled out in 3 other cases (hemorrhage in a patient with local recurrence, progressive disease with possible pulmonary infection, and grade 3 RP plus septicemia due to urinary tract infection). Estimated overall survival and local control rates were 95.5% and 100% at 6 months and 71.5% and 91.8% at 12 months. Updated follow-up will be available in October 2012. Conclusions: This risk-adapted hypofractionated stereotactic delivery scheme of 60Gy in 12 fractions is a feasible option in large and/or central lung tumors, in patients not fit to undergo standard chemoradiation therapy or surgery. Early experience suggests that toxicity is acceptable but longer follow-up is needed to better evaluate tumor control and therapeutic ratio. Author Disclosure: E. Bongers: J. Funding Other; Department has a Research Agreement with Varian Medical Systems. M.R. Dahele: F. Honoraria; Varian Medical Systems. H. Travel Expenses; Varian Medical Systems, Brainlab. C.J. Haasbeek: None. P.F. de Haan: None. W.F. Verbakel: H. Travel Expenses; Varian Medical Systems. B.J. Slotman: H. Travel Expenses; Varian Medical Systems. J. Funding Other; Speaker Fee Varian Medical Systems. S. Senan: F. Honoraria; Varian Medical Systems. H. Travel Expenses; Varian Medical Systems.
Results: The complete response (CR) was 1 patient; the partial response (PR) was 31 patients. The overall tumor response (CR+PR) rate was 96.97% (32/33). The 1-,2- year survival rates were respectively 68.2%, 43.0%. The 1-,2- year local control rates were respectively 95.8%, 72.8%. The acute pneumonitis and esophagitis incidence rates were 36.36% and 33.33% respectively. No grade III/IV radiation pneumonitis or esophagitis was observed. The leukocytopenia rate was 39.39%, and there was 1 case of grade III. Conclusion: The SIB-CR technique for non-small cell lung cancer was feasible and with a higher tumor response. Radiation toxicities can be well tolerated. The late toxicities and long-term survival need to be observed. Author Disclosure: X. Qiao: None. J. Li: None. Y. Song: None. Z. Zhou: None. C. Zhen: None.
2884 Prospective Study of Simultaneous Integrated Boost Conformal Radiation Therapy in Locally Advanced Central Non-small Cell Lung Cancer X. Qiao, J. Li, Y. Song, Z. Zhou, and C. Zhen; Fourth Hospital, Hebei Medical University, Shijiazhuang, China Purpose/Objective(s): To evaluate the feasibility of simultaneous integrated boost conformal radiation therapy (SIB-CR) in patients with locally advanced central non-small cell lung cancer (LANSCLC). Materials/Methods: Thirty-three patients with LANSCLC treated with SIB-CR planning between December 2007 and July 2011. Simultaneous integrated boost conformal radiation therapy (SIB-CR) was used. The prescribed dose of PTV was 5040cGy/28fractions and GTV was given to 6440cGy/28fractions simultaneously. The total treatment time was about 5.5 weeks (1 time a day, 5 fractions a week).
2885 Involved-Field Radiation Therapy Using Protons or Carbon Ions for N1-2M0 Non-small Cell Lung Cancer: A Retrospective Study O. Fujii,1 N. Hashimoto,1 K. Terashima,1 M. Mima,1 Y. Demizu,1 Y. Niwa,1 R. Sasaki,2 Y. Hishikawa,1 M. Abe,1 and M. Murakami1; 1Hyogo Ion Beam Medical Center, Tatsuno, Japan, 2Kobe University Graduate School of Medicine, Kobe, Japan Purpose/Objective(s): Limited clinical data exists in the use of involved-field radiation therapy (IFRT) for node-positive lung cancer. The purpose of this study was to analyze the results of IFRT using protons or carbon ions for N1-2M0 non-small cell lung cancer (NSCLC) retrospectively. Materials/Methods: Between April 2003 and March 2011, a total of 45 patients with N1-2M0 NSCLC received proton or carbon ion radiation therapy. Among these patients, 9 patients were excluded from this study because eight were lost to follow-up and one had previously received irradiation to the recurrent site. The remaining 36 patients were identified and retrospectively analyzed. Twenty-nine patients were male and 7 were female. Median age was 76 years (range, 50-90). Eighteen patients had squamous carcinoma, 12 had adenocarcinoma and 6 had others. Thirtythree patients were medically inoperable and 3 refused surgery. The lung cancer was staged as T1N1M0, 3; T1N2M0, 3; T2N1M0, 9; T3N1M0, 2; T4N1M0, 7; T4N2M0, 5; rN1, 5; and rN2, 2. Twenty patients were treated with proton therapy of 65-80 GyE/10-40 fractions and 16 patients with carbon ion therapy of 57.6-70.2 GyE/10-26 fractions. Survival and local control were evaluated using the Kaplan-Meier method. Acute and late morbidities were assessed based on the Common Terminology Criteria for Adverse Events (CTCAE) v3.0. The median follow-up time was 16 months (range, 5-89 months). Results: The actuarial 2-year rates of overall survival, progression-free survival, local control and elective nodal control were 64%, 52%, 77% and 93%, respectively. Local progression occurred in 6 patients (17%). Elective nodal and distant metastases were observed in 3 patients (8%) and 14 patients (39%), respectively. Grade3 acute reactions were observed in 4 patients (dermatitis in 3 and esophagitis in 1); however no patients discontinued the treatment. Grade3 and 4 late adverse events were observed in 6 patients (pneumonitis) and 1 (esophagotracheal fistula), respectively. Conclusions: This study showed that IFRT using protons or carbon ions for N1-2M0 NSCLC provided favorable outcome with acceptable toxicity, therefore serving as an effective treatment option especially for medically inoperable N1-2M0 NSCLC. More accumulation of patients and longer follow-up would be warranted. Author Disclosure: O. Fujii: None. N. Hashimoto: None. K. Terashima: None. M. Mima: None. Y. Demizu: None. Y. Niwa: None. R. Sasaki: None. Y. Hishikawa: None. M. Abe: None. M. Murakami: None.
2886 Stereotactic Body Radiation Therapy for Lung Cancer in Octogenarians T. Ishihara, K. Yamada, M. Tanahashi, H. Niwa, T. Matsui, K. Yokomura, and R. Sasaki; Seirei Mikatahara General Hospital, Hamamatsu, Japan