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P2.05-050 Impact of Inflammation and Sarcopenia on Outcomes after Stereotactic Body Radiotherapy for T1N0M0 Non-Small Cell Lung Cancer
S1062
Methods: NSCLC patients from the Beatson West of Scotland Cancer Centre (a specialized cancer care center serving a population of 2.4m), treated with radical radiotherapy between September 2014 to December 2015, were offered followed up by a specialist nurse led clinic. This consisted of a telephone consultation at 2 weeks and clinic attendance at 2 and 6 months. Patient and tumor demographics were collected. Side effects were recorded at each visit and graded using the Common Terminology Criteria for Adverse Events (CTCAE). Descriptive statistical analysis was performed using Stata 14.0. Results: 92 consecutive patients attended the clinic, 50% were male and the median age was 70 (IQR 63.578) years. 48 patients had squamous carcinoma and all were performance status 0 e 2. The breakdown was 16% 23% and 56% for stage I, II and III respectively. A total of 62 (67%) of patients received 55Gy in 20 fractions. Overall one-year survival was 59.7% (95%CI 47.070.3%). Information from 75% was obtained by telephone at 2 weeks and in clinic at 8 weeks post treatment. At 6 months 54% attended for assessment. The most commonly reported side effects at week 2 were fatigue (90%), dyspnoea (70%), oesophagitis (70%), anorexia (26%) and cough (21%). At week 8 side effects were similar except that oesophagitis had decreased to 23% (p<0.001), and cough increased to 30% (p¼0.07). All side-effects were graded 2 or less with the exception of one patient with grade 3 oesophagitis at week 8. Conclusion: This study confirmed a high level of patient engagement with a nurse led follow up protocol which was able to capture detailed information about frequency and severity of side effects following radical thoracic radiotherapy. This confirmed that the side effects patients experience were temporary and manageable. Keywords: NSCLC, toxicities, radical radiotherapy
P2.05-050 Impact of Inflammation and Sarcopenia on Outcomes after Stereotactic Body Radiotherapy for T1N0M0 Non-Small Cell Lung Cancer Topic: Toxicities Yukinori Matsuo,1 Yasushi Nagata,2 Masashi Wakabayashi,3 Junko Eba,3 Satoshi Ishikura,4 Hiroshi Onishi,5 Masaki Kokubo,6 Katsuyuki Karasawa,7 Yoshiyuki Shioyama,8 Rikiya Onimaru,9 Masahiro Hiraoka1 1Kyoto
Journal of Thoracic Oncology
Vol. 12 No. 1S
University, Kyoto University, Kyoto/Japan, 2Department of Radiation Oncology, Hiroshima University, Hiroshima/ Japan, 3Jcog Data Center/operations Office, National Cancer Center, Tokyo/Japan, 4Department of Radiology, Koshigaya Municipal Hospital, Koshigaya/Japan, 5 Department of Radiology, University of Yamanashi, Yamanashi/Japan, 6Institute of Biomedical Research and Innovation, Kobe/Japan, 7Tokyo Metropolitan Komagome Hospital, Tokyo/Japan, 8Kyushu University, Fukuoka/ Japan, 9Department of Radiation Medicine, Hokkaido University, Sapporo/Japan Background: The purpose was to evaluate impact of systemic inflammation and sarcopenia on outcomes after stereotactic body radiotherapy (SBRT) for T1N0M0 nonsmall cell lung cancer (NSCLC) as a supplementary analysis of Japan Clinical Oncology Group (JCOG) study JCOG0403. Methods: Pretreatment serum C-reactive protein (CRP) was used as a marker for systemic inflammation. Patients were divided into high and low CRP groups with a threshold value of 0.3 mg/dL. Paraspinous musculature area (PMA) at a level of the 12th thoracic vertebra was measured on simulation CT with thresholding Hounsfield Units between -29 and 150. When PMA was lower than the gender-specific median, the patient was classified as sarcopenia. Toxicities, overall survival (OS) and cumulative incidence of cause-specific death were compared between groups. Kaplan-Meier method and cumulative incidence function were applied to estimate proportion of OS and cumulative incidence of causespecific death, respectively. Results: Of 169 patients enrolled into JCOG0403, 60 operable and 92 inoperable patients were included into this study after excluding 5 patients ineligible for JCOG0403 and 12 patients whose simulation CT images were unavailable or unsuitable for the PMA measurement. Forty-two patients were classified as high CRP. Medians of PMA were 31.6 cm2 (range, 12.6-52.9) and 25.1 cm2 (range, 3.4-38.5) in male and female, respectively. Proportions of toxicities Grade 3-4 were 19.1% and 10.9% in the high and low CRP groups; and 17.1% and 9.2% in the sarcopenia and non-sarcopenia groups, respectively. In the operable patient cohort, OS significantly differed between the CRP groups (log-rank test P¼0.009; hazard ratio of high CRP 2.43, 95% confidence interval 1.23-4.80; 3-year OS of 58.8% and 83.6% for high and low CRP, respectively). This difference in OS was mainly contributed by difference in lung cancer death (Gray’s test P¼0.070; 3-year cumulative incidence of 29.4% and 7.1%, respectively). No impact of sarcopenia on OS was observed in operable patients. In the inoperable patient cohort, OS did not differ between the CRP groups (log-rank test P ¼ 0.925). No significant
January 2017
difference was observed in OS between the sarcopenia groups, either. Conclusion: The present study suggests that systemic inflammation may provide prognostic information for operable patients receiving SBRT for early-stage NSCLC. Further studies are warranted to confirm these findings. Keywords: systemic inflammation, SBRT, sarcopenia
P2.05-051 Safety of Lung Stereotactic Body Radiotherapy (SBRT): A Single Institution Prospective Study Based on RTOG 0915 Protocol Constraints Topic: Toxicities Valentina Vanoni,1 Anna Delana,2 Andrea Martignano,2 Salvatore Mussari,1 Christine Seebacher,3 Emanuela Vattemi,3 Antonello Veccia,4 Luigi Tomio1 1Radiotherapy, S. Chiara Hospital, Trento/Italy, 2Medical Physics, S. Chiara Hospital, Trento/Italy, 3Pneumology, S. Maurizio Hospital, Bolzano/Italy, 4Medical Oncology, S. Chiara Hospital, Trento/Italy Background: To evaluate toxicity of RTOG 0915 protocol’s constraints in lung SBRT for patients treated with 60Gy in 5 fractions. Methods: Between 2010 and 2015, 77 pts were treated with SBRT for single or multiple lung lesions, 43 pts (55.8%) for primary tumor and 34 pts (44.2%) for metastatic lesion. A total of 80 lesions were treated. Four dimensional CT images were acquired; maximum intensity CT reconstruction was used for ITV delineation and average CT reconstruction for OAR contouring and dosimetric calculation.We prescribed 57Gy to 95% of PTV volume and OAR constraints are reported in table 1.
Abstracts
S1063
Dose calculation was performed in 70% of the cases with collapsed cone convolution algorithm and 7 fields 3D technique and the remaining 30% with Monte Carlo dose calculation and intensity modulated fields (dynamic MLC and VMAT tecniques). Treatments were delivered in 28% of the cases on Elekta-Precise accelerator with electronic portal films on-line setup verifications and the remaining 72% on Elekta-Agility accelerator with cone beam CT. We evaluated pre-treatment respiratory function and we treated only pts with %FEV1 > 40%. We reported toxicity following CTCAE v3.0 score. Results: All the dose/constraints were respected except for the chest wall dose that was higher than 30 Gy in 8 pts (10.3%). Toxicity was evaluated in all the patients except one that was lost in follow-up. We found only lung or chest wall toxicity: 11 pts (14.2%) with a G2 dyspnea, one patient with a G3 dyspnea; 8 pts with a G2 chest wall pain and 1 with a symptomatic rib fracture. We find more lung toxicity in patients with primary tumor because of more chronic lung disease prior to the treatment. Conclusion: The use of these SBRT constraints is safe in both metastatic and primary lung lesions, with a particular attention on pre-treatment respiratory function. Keywords: SBRT, NSCLC, toxicity
P2.05-052 A Systematic Review and Meta-Analysis of Pneumonitis in Radically Treated NSCLC Patients: SABR. vs. Non-SABR Treatment Topic: Toxicities Fiona Hegi-Johnson,1 Maria Azzi,2 Mario D’Souza3 Radiation Physics Laboratory, University of Sydney, Sydney/Australia, 2Central Coast Cancer Care Centre, Gosford/NSW/Australia, 3University of Sydney, Sydney/ Australia 1
Background: SABR is popular because of the high rates of local control seen in lung cancer patients. However, prospective head to head trial data comparing the toxicity of SABR to conventionally fractionated radiotherapy are still awaited. We compare pneumonitis rates in SABR vs. non-SABR treatment for early stage lung cancer patients. Methods: A PUBMED search of all human, English language papers on SABR and on-SABR radically treated
Methods: NSCLC patients from the Beatson West of Scotland Cancer Centre (a specialized cancer care center serving a population of 2.4m), treated with radical radiotherapy between September 2014 to December 2015, were offered followed up by a specialist nurse led clinic. This consisted of a telephone consultation at 2 weeks and clinic attendance at 2 and 6 months. Patient and tumor demographics were collected. Side effects were recorded at each visit and graded using the Common Terminology Criteria for Adverse Events (CTCAE). Descriptive statistical analysis was performed using Stata 14.0. Results: 92 consecutive patients attended the clinic, 50% were male and the median age was 70 (IQR 63.578) years. 48 patients had squamous carcinoma and all were performance status 0 e 2. The breakdown was 16% 23% and 56% for stage I, II and III respectively. A total of 62 (67%) of patients received 55Gy in 20 fractions. Overall one-year survival was 59.7% (95%CI 47.070.3%). Information from 75% was obtained by telephone at 2 weeks and in clinic at 8 weeks post treatment. At 6 months 54% attended for assessment. The most commonly reported side effects at week 2 were fatigue (90%), dyspnoea (70%), oesophagitis (70%), anorexia (26%) and cough (21%). At week 8 side effects were similar except that oesophagitis had decreased to 23% (p<0.001), and cough increased to 30% (p¼0.07). All side-effects were graded 2 or less with the exception of one patient with grade 3 oesophagitis at week 8. Conclusion: This study confirmed a high level of patient engagement with a nurse led follow up protocol which was able to capture detailed information about frequency and severity of side effects following radical thoracic radiotherapy. This confirmed that the side effects patients experience were temporary and manageable. Keywords: NSCLC, toxicities, radical radiotherapy
P2.05-050 Impact of Inflammation and Sarcopenia on Outcomes after Stereotactic Body Radiotherapy for T1N0M0 Non-Small Cell Lung Cancer Topic: Toxicities Yukinori Matsuo,1 Yasushi Nagata,2 Masashi Wakabayashi,3 Junko Eba,3 Satoshi Ishikura,4 Hiroshi Onishi,5 Masaki Kokubo,6 Katsuyuki Karasawa,7 Yoshiyuki Shioyama,8 Rikiya Onimaru,9 Masahiro Hiraoka1 1Kyoto
Journal of Thoracic Oncology
Vol. 12 No. 1S
University, Kyoto University, Kyoto/Japan, 2Department of Radiation Oncology, Hiroshima University, Hiroshima/ Japan, 3Jcog Data Center/operations Office, National Cancer Center, Tokyo/Japan, 4Department of Radiology, Koshigaya Municipal Hospital, Koshigaya/Japan, 5 Department of Radiology, University of Yamanashi, Yamanashi/Japan, 6Institute of Biomedical Research and Innovation, Kobe/Japan, 7Tokyo Metropolitan Komagome Hospital, Tokyo/Japan, 8Kyushu University, Fukuoka/ Japan, 9Department of Radiation Medicine, Hokkaido University, Sapporo/Japan Background: The purpose was to evaluate impact of systemic inflammation and sarcopenia on outcomes after stereotactic body radiotherapy (SBRT) for T1N0M0 nonsmall cell lung cancer (NSCLC) as a supplementary analysis of Japan Clinical Oncology Group (JCOG) study JCOG0403. Methods: Pretreatment serum C-reactive protein (CRP) was used as a marker for systemic inflammation. Patients were divided into high and low CRP groups with a threshold value of 0.3 mg/dL. Paraspinous musculature area (PMA) at a level of the 12th thoracic vertebra was measured on simulation CT with thresholding Hounsfield Units between -29 and 150. When PMA was lower than the gender-specific median, the patient was classified as sarcopenia. Toxicities, overall survival (OS) and cumulative incidence of cause-specific death were compared between groups. Kaplan-Meier method and cumulative incidence function were applied to estimate proportion of OS and cumulative incidence of causespecific death, respectively. Results: Of 169 patients enrolled into JCOG0403, 60 operable and 92 inoperable patients were included into this study after excluding 5 patients ineligible for JCOG0403 and 12 patients whose simulation CT images were unavailable or unsuitable for the PMA measurement. Forty-two patients were classified as high CRP. Medians of PMA were 31.6 cm2 (range, 12.6-52.9) and 25.1 cm2 (range, 3.4-38.5) in male and female, respectively. Proportions of toxicities Grade 3-4 were 19.1% and 10.9% in the high and low CRP groups; and 17.1% and 9.2% in the sarcopenia and non-sarcopenia groups, respectively. In the operable patient cohort, OS significantly differed between the CRP groups (log-rank test P¼0.009; hazard ratio of high CRP 2.43, 95% confidence interval 1.23-4.80; 3-year OS of 58.8% and 83.6% for high and low CRP, respectively). This difference in OS was mainly contributed by difference in lung cancer death (Gray’s test P¼0.070; 3-year cumulative incidence of 29.4% and 7.1%, respectively). No impact of sarcopenia on OS was observed in operable patients. In the inoperable patient cohort, OS did not differ between the CRP groups (log-rank test P ¼ 0.925). No significant
January 2017
difference was observed in OS between the sarcopenia groups, either. Conclusion: The present study suggests that systemic inflammation may provide prognostic information for operable patients receiving SBRT for early-stage NSCLC. Further studies are warranted to confirm these findings. Keywords: systemic inflammation, SBRT, sarcopenia
P2.05-051 Safety of Lung Stereotactic Body Radiotherapy (SBRT): A Single Institution Prospective Study Based on RTOG 0915 Protocol Constraints Topic: Toxicities Valentina Vanoni,1 Anna Delana,2 Andrea Martignano,2 Salvatore Mussari,1 Christine Seebacher,3 Emanuela Vattemi,3 Antonello Veccia,4 Luigi Tomio1 1Radiotherapy, S. Chiara Hospital, Trento/Italy, 2Medical Physics, S. Chiara Hospital, Trento/Italy, 3Pneumology, S. Maurizio Hospital, Bolzano/Italy, 4Medical Oncology, S. Chiara Hospital, Trento/Italy Background: To evaluate toxicity of RTOG 0915 protocol’s constraints in lung SBRT for patients treated with 60Gy in 5 fractions. Methods: Between 2010 and 2015, 77 pts were treated with SBRT for single or multiple lung lesions, 43 pts (55.8%) for primary tumor and 34 pts (44.2%) for metastatic lesion. A total of 80 lesions were treated. Four dimensional CT images were acquired; maximum intensity CT reconstruction was used for ITV delineation and average CT reconstruction for OAR contouring and dosimetric calculation.We prescribed 57Gy to 95% of PTV volume and OAR constraints are reported in table 1.
Abstracts
S1063
Dose calculation was performed in 70% of the cases with collapsed cone convolution algorithm and 7 fields 3D technique and the remaining 30% with Monte Carlo dose calculation and intensity modulated fields (dynamic MLC and VMAT tecniques). Treatments were delivered in 28% of the cases on Elekta-Precise accelerator with electronic portal films on-line setup verifications and the remaining 72% on Elekta-Agility accelerator with cone beam CT. We evaluated pre-treatment respiratory function and we treated only pts with %FEV1 > 40%. We reported toxicity following CTCAE v3.0 score. Results: All the dose/constraints were respected except for the chest wall dose that was higher than 30 Gy in 8 pts (10.3%). Toxicity was evaluated in all the patients except one that was lost in follow-up. We found only lung or chest wall toxicity: 11 pts (14.2%) with a G2 dyspnea, one patient with a G3 dyspnea; 8 pts with a G2 chest wall pain and 1 with a symptomatic rib fracture. We find more lung toxicity in patients with primary tumor because of more chronic lung disease prior to the treatment. Conclusion: The use of these SBRT constraints is safe in both metastatic and primary lung lesions, with a particular attention on pre-treatment respiratory function. Keywords: SBRT, NSCLC, toxicity
P2.05-052 A Systematic Review and Meta-Analysis of Pneumonitis in Radically Treated NSCLC Patients: SABR. vs. Non-SABR Treatment Topic: Toxicities Fiona Hegi-Johnson,1 Maria Azzi,2 Mario D’Souza3 Radiation Physics Laboratory, University of Sydney, Sydney/Australia, 2Central Coast Cancer Care Centre, Gosford/NSW/Australia, 3University of Sydney, Sydney/ Australia 1
Background: SABR is popular because of the high rates of local control seen in lung cancer patients. However, prospective head to head trial data comparing the toxicity of SABR to conventionally fractionated radiotherapy are still awaited. We compare pneumonitis rates in SABR vs. non-SABR treatment for early stage lung cancer patients. Methods: A PUBMED search of all human, English language papers on SABR and on-SABR radically treated