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CT Are Possible Prognostic Factors for Stage I Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy
E426
International Journal of Radiation Oncology Biology Physics
3060
year OS and LC rates were 32.7% and 63.5%, respectively. Nine patients had local recurrence and 11 patients had distant organ metastases. Eleven patients died of the primary disease and 13 patients died of other causes. In univariate analyses, gender (pZ0.046), tumor size (pZ0.017), MTV２ (pZ0.019), MTV４ (pZ0.028), TLG40% (pZ0.037), TLG50% (pZ0.038) and TLG60% (pZ0.046) were significant predictors for OS. Tumor size (P<0.001), MTV２ (p<0.001), MTV４ (pZ0.005), MTV6 (pZ0.029), TLG40% (p<0.001), TLG50% (pZ0.002) and TLG60% (pZ0.004) were significant predictors for LC. SUVmax was not a significant predictor for OS or LC. The log-rank test showed that lower SUVmax (pZ0.0443), MTV2 (pZ0.0081) and MTV4 (pZ0.0345) were associated with significantly better OS and that lower TLG40% (pZ0.0396) was associated with significantly better LC. The largest AUC for OS was MTV2, and the largest AUC for LC was TLG40%. The AUC for LC of TLG40% was significantly different from the AUC for SUVmax (pZ0.0461). Conclusion: Our results suggested that tumor size, MTV and TLG are prognostic factors in patients with stage I lung cancer treated by SBRT. MTV and TLG are better prognostic factors than SUVmax for OS and LC. Author Disclosure: N. Takahashi: None. T. Yamamoto: None. K. Jingu: None. H. Matsushita: None. T. Sugawara: None. M. Kubozono: None. R. Umezawa: None. Y. Ishikawa: None. M. Kozumi: None. Y. Katagiri: None. K. Takeda: None.
High Dose (74 GyE) Proton Beam Therapy With Concurrent Chemotherapy for Stage III Non-Small Cell Lung Cancer K. Ohnishi, T. Okumura, H. Ishikawa, Y. Oshiro, M. Mizumoto, K. Murofushi, H. Numajiri, N. Fukumitsu, T. Aihara, K. Tsuboi, and H. Sakurai; University of Tsukuba, Tsukuba, Japan Purpose/Objective(s): To evaluate the clinical outcome of high-dose (74 Gy RBE) proton beam therapy (PBT) with concurrent chemotherapy for unresectable locally advanced non-small cell lung cancer (NSCLC). Materials/Methods: Between 2007 and 2013, 31 patients with locally advanced NSCLC were treated with PBT and chemotherapy concurrently. The prescribed dose was 74 Gy RBE to the primary tumor and 66 Gy RBE to the metastatic lymph nodes. Adapted planning was made during the treatment. Cisplatin- or carboplatin-based chemotherapy was used. Twenty-four of 31 patients were men, and the median age was 63 years (range, 40-79 years). The clinical stage was Stage IIIA in 8 patients and Stage IIIB in 23 patients. Results: At the last follow-up, 13 of 31 patients were dead of disease, 2 patients were dead of other diseases, 11 patients were alive with disease, and 5 patients were alive without disease. The median follow-up time was 21 months for all patients and 37 months for surviving patients. The 2-year overall survival, disease-specific survival, and progression-free survival rates were 61%, 65%, and 22%, respectively. The median survival time was 39 months. Sixteen patients developed locoregional recurrences at intra-thorax and/or supraclavicular node (inside the field: 12, outside the field: 3, inside and outside the field: 1). The 2-year locoregional control rate was 53%. No Grade 4 or 5 acute and late non-hematologic toxicities were observed. Grade 3 acute dermatitis and esophagitis were seen in 3 and 2 patients, respectively. Three patients experienced Grade 3 radiation pneumonitis. Conclusion: High-dose PBT with concurrent chemotherapy for locally advanced NSCLC is a safe and effective treatment option. Author Disclosure: K. Ohnishi: None. T. Okumura: None. H. Ishikawa: None. Y. Oshiro: None. M. Mizumoto: None. K. Murofushi: None. H. Numajiri: None. N. Fukumitsu: None. T. Aihara: None. K. Tsuboi: None. H. Sakurai: None.
3061 Metabolic Tumor Volume and Total Lesion Glycolysis on FDG-PET/CT Are Possible Prognostic Factors for Stage I Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy N. Takahashi,1 T. Yamamoto,1 K. Jingu,1 H. Matsushita,2 T. Sugawara,1 M. Kubozono,1 R. Umezawa,3 Y. Ishikawa,1 M. Kozumi,1 Y. Katagiri,1 and K. Takeda4; 1Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan, 2Tohoku University Graduate School of Medicine, Sendai, Japan, 3National Cancer Center Hospital, Tokyo, Japan, 4Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan Purpose/Objective(s): The aim of this study was to determine whether metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are associated with outcomes in stage I lung cancer patients treated with stereotactic body radiation therapy (SBRT). Materials/Methods: A total of 47 patients with 48 lesions (37 males, 10 females) with stage I lung cancer underwent FDG-PET/CT before SBRT at our institution between January 2001 and December 2011. Nineteen lesions were adenocarcinomas, 12 lesions were squamous cell carcinomas, 2 lesions were non-small cell carcinomas and 15 lesions were pathologically unclear. MTVmax, MTV2, MTV4, MTV6, TLG40%, TLG50% and TLG60% were calculated. Prognostic factors for overall survival (OS) and local control (LC) were analyzed using Cox’s proportional hazards regression model, and survival curves were calculated using the Kaplan-Meier method. Receiver operating characteristics curves (ROC curves) of PET parameters for OS and LC were calculated. The values of area under the curve (AUC) of PET parameters were compared by using the X2 test. Results: The median follow-up period for survivors was 36.9 months. Three-year OS and LC rates were 57.3% and 75.9%, respectively, and 5-
3062 Hypofractionated Proton Beam Therapy for Early-Stage Large Central Lung Cancer: Early Acute Toxicity Assessment B.H. Chon,1 C.C. Chen,2 C. Brown,3 J.K. Davis,4 H.K. Tsai,1 E.B. Hug,5 K. Sine,5 D. Mah,5 and O. Cahlon6; 1Princeton Radiation Oncology, Princeton, NJ, 2Procure Proton Treatment Center New Jersey, Somerset, NJ, 3Procure Proton Therapy Center New Jersey, Somerset, NJ, 4Procure Proton Therapy, Somerset, NJ, 5ProCure Proton Therapy Center New Jersey, Somerset, NJ, 6Memorial Sloan Kettering Cancer Center, New York, NY Purpose/Objective(s): The role of proton beam therapy for lung cancer is evolving. In this study, we report our early institutional experience on the acute tolerance and early efficacy and safety of proton beam therapy (PBT) for early stage, large central non-small cell lung cancer (NSCLC). Materials/Methods: Ten patients with early stage, large, centrally located NSCLC were treated to 60-70 Gy (RBE) in 14-15 fractions. All patients had centrally located lung lesions within 2.5 cm of the bronchial tree, trachea, major vessels, esophagus, heart, pericardium, brachial plexus, or vertebral body. Median tumor size was 4.8 cm. Eight of 10 patients underwent 4D-CT simulation. Two patients were simulated with a slow pitch CT scan due to minimal respiration motion. Planning CTs were fused with available PET/CTs for ITV delineation. PTVs were created by expanding the ITVs by 5mm-12mm based on patient specific respiratory motion, setup and range uncertainties. All patients were treated with uniform scanning techniques with a minimum of 3 beams. Daily orthogonal KV imaging was performed and aligned to bony anatomy and the carina. Serial CT scans were performed during the planned course of therapy to assess tumor response and reproducibility of set up. New treatment plans were constructed when significant tumor regression was observed. Results: The median follow up period was 7.3 months. Actuarial local, regional, and distant control were 100%, 100%, and 88%, respectively. The mean V95% of PTV was 95.4% (range: 88.0%-99.8%), while the maximum V20Gy (RBE) and V10Gy (RBE) of normal lung were 15.9% and 21.9%, respectively. The maximum dose to spinal cord ranged from 0 to 26.8 Gy (RBE) depending on the tumor locations. Two patients reported grade 1 esophagitis (Dmax of esophagus > 30 CGE for both cases) and 1 patient noted grade 1 chest wall pain. There was no reported incidence of pneumonitis, pericarditis, or rib fractures. There was no reported Grade 2 or higher toxicities. Conclusion: PBT for central, large NSCLC was well tolerated. No grade 2 or higher toxicities was reported. Further investigation is warranted. Author Disclosure: B.H. Chon: None. C.c. Chen: None. C. Brown: None. J.K. Davis: None. H.K. Tsai: None. E.B. Hug: None. K. Sine: None. D. Mah: None. O. Cahlon: None.
International Journal of Radiation Oncology Biology Physics
3060
year OS and LC rates were 32.7% and 63.5%, respectively. Nine patients had local recurrence and 11 patients had distant organ metastases. Eleven patients died of the primary disease and 13 patients died of other causes. In univariate analyses, gender (pZ0.046), tumor size (pZ0.017), MTV２ (pZ0.019), MTV４ (pZ0.028), TLG40% (pZ0.037), TLG50% (pZ0.038) and TLG60% (pZ0.046) were significant predictors for OS. Tumor size (P<0.001), MTV２ (p<0.001), MTV４ (pZ0.005), MTV6 (pZ0.029), TLG40% (p<0.001), TLG50% (pZ0.002) and TLG60% (pZ0.004) were significant predictors for LC. SUVmax was not a significant predictor for OS or LC. The log-rank test showed that lower SUVmax (pZ0.0443), MTV2 (pZ0.0081) and MTV4 (pZ0.0345) were associated with significantly better OS and that lower TLG40% (pZ0.0396) was associated with significantly better LC. The largest AUC for OS was MTV2, and the largest AUC for LC was TLG40%. The AUC for LC of TLG40% was significantly different from the AUC for SUVmax (pZ0.0461). Conclusion: Our results suggested that tumor size, MTV and TLG are prognostic factors in patients with stage I lung cancer treated by SBRT. MTV and TLG are better prognostic factors than SUVmax for OS and LC. Author Disclosure: N. Takahashi: None. T. Yamamoto: None. K. Jingu: None. H. Matsushita: None. T. Sugawara: None. M. Kubozono: None. R. Umezawa: None. Y. Ishikawa: None. M. Kozumi: None. Y. Katagiri: None. K. Takeda: None.
High Dose (74 GyE) Proton Beam Therapy With Concurrent Chemotherapy for Stage III Non-Small Cell Lung Cancer K. Ohnishi, T. Okumura, H. Ishikawa, Y. Oshiro, M. Mizumoto, K. Murofushi, H. Numajiri, N. Fukumitsu, T. Aihara, K. Tsuboi, and H. Sakurai; University of Tsukuba, Tsukuba, Japan Purpose/Objective(s): To evaluate the clinical outcome of high-dose (74 Gy RBE) proton beam therapy (PBT) with concurrent chemotherapy for unresectable locally advanced non-small cell lung cancer (NSCLC). Materials/Methods: Between 2007 and 2013, 31 patients with locally advanced NSCLC were treated with PBT and chemotherapy concurrently. The prescribed dose was 74 Gy RBE to the primary tumor and 66 Gy RBE to the metastatic lymph nodes. Adapted planning was made during the treatment. Cisplatin- or carboplatin-based chemotherapy was used. Twenty-four of 31 patients were men, and the median age was 63 years (range, 40-79 years). The clinical stage was Stage IIIA in 8 patients and Stage IIIB in 23 patients. Results: At the last follow-up, 13 of 31 patients were dead of disease, 2 patients were dead of other diseases, 11 patients were alive with disease, and 5 patients were alive without disease. The median follow-up time was 21 months for all patients and 37 months for surviving patients. The 2-year overall survival, disease-specific survival, and progression-free survival rates were 61%, 65%, and 22%, respectively. The median survival time was 39 months. Sixteen patients developed locoregional recurrences at intra-thorax and/or supraclavicular node (inside the field: 12, outside the field: 3, inside and outside the field: 1). The 2-year locoregional control rate was 53%. No Grade 4 or 5 acute and late non-hematologic toxicities were observed. Grade 3 acute dermatitis and esophagitis were seen in 3 and 2 patients, respectively. Three patients experienced Grade 3 radiation pneumonitis. Conclusion: High-dose PBT with concurrent chemotherapy for locally advanced NSCLC is a safe and effective treatment option. Author Disclosure: K. Ohnishi: None. T. Okumura: None. H. Ishikawa: None. Y. Oshiro: None. M. Mizumoto: None. K. Murofushi: None. H. Numajiri: None. N. Fukumitsu: None. T. Aihara: None. K. Tsuboi: None. H. Sakurai: None.
3061 Metabolic Tumor Volume and Total Lesion Glycolysis on FDG-PET/CT Are Possible Prognostic Factors for Stage I Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy N. Takahashi,1 T. Yamamoto,1 K. Jingu,1 H. Matsushita,2 T. Sugawara,1 M. Kubozono,1 R. Umezawa,3 Y. Ishikawa,1 M. Kozumi,1 Y. Katagiri,1 and K. Takeda4; 1Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan, 2Tohoku University Graduate School of Medicine, Sendai, Japan, 3National Cancer Center Hospital, Tokyo, Japan, 4Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Sendai, Japan Purpose/Objective(s): The aim of this study was to determine whether metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are associated with outcomes in stage I lung cancer patients treated with stereotactic body radiation therapy (SBRT). Materials/Methods: A total of 47 patients with 48 lesions (37 males, 10 females) with stage I lung cancer underwent FDG-PET/CT before SBRT at our institution between January 2001 and December 2011. Nineteen lesions were adenocarcinomas, 12 lesions were squamous cell carcinomas, 2 lesions were non-small cell carcinomas and 15 lesions were pathologically unclear. MTVmax, MTV2, MTV4, MTV6, TLG40%, TLG50% and TLG60% were calculated. Prognostic factors for overall survival (OS) and local control (LC) were analyzed using Cox’s proportional hazards regression model, and survival curves were calculated using the Kaplan-Meier method. Receiver operating characteristics curves (ROC curves) of PET parameters for OS and LC were calculated. The values of area under the curve (AUC) of PET parameters were compared by using the X2 test. Results: The median follow-up period for survivors was 36.9 months. Three-year OS and LC rates were 57.3% and 75.9%, respectively, and 5-
3062 Hypofractionated Proton Beam Therapy for Early-Stage Large Central Lung Cancer: Early Acute Toxicity Assessment B.H. Chon,1 C.C. Chen,2 C. Brown,3 J.K. Davis,4 H.K. Tsai,1 E.B. Hug,5 K. Sine,5 D. Mah,5 and O. Cahlon6; 1Princeton Radiation Oncology, Princeton, NJ, 2Procure Proton Treatment Center New Jersey, Somerset, NJ, 3Procure Proton Therapy Center New Jersey, Somerset, NJ, 4Procure Proton Therapy, Somerset, NJ, 5ProCure Proton Therapy Center New Jersey, Somerset, NJ, 6Memorial Sloan Kettering Cancer Center, New York, NY Purpose/Objective(s): The role of proton beam therapy for lung cancer is evolving. In this study, we report our early institutional experience on the acute tolerance and early efficacy and safety of proton beam therapy (PBT) for early stage, large central non-small cell lung cancer (NSCLC). Materials/Methods: Ten patients with early stage, large, centrally located NSCLC were treated to 60-70 Gy (RBE) in 14-15 fractions. All patients had centrally located lung lesions within 2.5 cm of the bronchial tree, trachea, major vessels, esophagus, heart, pericardium, brachial plexus, or vertebral body. Median tumor size was 4.8 cm. Eight of 10 patients underwent 4D-CT simulation. Two patients were simulated with a slow pitch CT scan due to minimal respiration motion. Planning CTs were fused with available PET/CTs for ITV delineation. PTVs were created by expanding the ITVs by 5mm-12mm based on patient specific respiratory motion, setup and range uncertainties. All patients were treated with uniform scanning techniques with a minimum of 3 beams. Daily orthogonal KV imaging was performed and aligned to bony anatomy and the carina. Serial CT scans were performed during the planned course of therapy to assess tumor response and reproducibility of set up. New treatment plans were constructed when significant tumor regression was observed. Results: The median follow up period was 7.3 months. Actuarial local, regional, and distant control were 100%, 100%, and 88%, respectively. The mean V95% of PTV was 95.4% (range: 88.0%-99.8%), while the maximum V20Gy (RBE) and V10Gy (RBE) of normal lung were 15.9% and 21.9%, respectively. The maximum dose to spinal cord ranged from 0 to 26.8 Gy (RBE) depending on the tumor locations. Two patients reported grade 1 esophagitis (Dmax of esophagus > 30 CGE for both cases) and 1 patient noted grade 1 chest wall pain. There was no reported incidence of pneumonitis, pericarditis, or rib fractures. There was no reported Grade 2 or higher toxicities. Conclusion: PBT for central, large NSCLC was well tolerated. No grade 2 or higher toxicities was reported. Further investigation is warranted. Author Disclosure: B.H. Chon: None. C.c. Chen: None. C. Brown: None. J.K. Davis: None. H.K. Tsai: None. E.B. Hug: None. K. Sine: None. D. Mah: None. O. Cahlon: None.