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Postoperative Proton Therapy for Resected Non-Small Cell Lung Cancer
Poster Viewing Session E419
Volume 93 Number 3S Supplement 2015 between primary (8%) and recurrent (48%) lesions with log rank analysis showing p-value of 0.03. Twenty-four percent of patients failed distally at 3-years, with similar failure rates among primary and recurrent subsets. Analysis of toxicity revealed no grade 4 or 5 events. Three grade 3 events were reported, consisting of rib fracture, pneumonitis, and pleural effusion. Grade 2 toxicity occurred in 10 patients, including dyspnea (1), chest wall pain (2), pneumonitis (4), rib fracture (1), and cough (2). Conclusion: Moderate prescription dosing, treated once weekly offers acceptable local control rates for centrally located tumors including recurrent mediastinal and hilar lymph nodes. Toxicity was minimal with a majority of patients experiencing no treatment related adverse events. Author Disclosure: J.R. Bowers: None. M. Richardson: None. K.M. Spencer: None. J. Contreras: None. S. Francis: None. N.R. Bennion: None. H. Lomas: None. J.M. Larner: None. R. Kersh: None.
3044 Postoperative Proton Therapy for Resected Non-Small Cell Lung Cancer R.L. Deraniyagala,1 B.S. Hoppe,1 C.G. Morris,2 D.C. Pham,3 H.J. D’Agostino,4 A. Bajwa,3 S. Flampouri,1 S.N. Huh,1 and R.C. Nichols, Jr1; 1University of Florida Health Proton Therapy Institute, Jacksonville, FL, 2University of Florida, Gainesville, FL, 3Department of Medicine, University of Florida, Jacksonville, FL, 4Department of Surgery, University of Florida, Jacksonville, FL Purpose/Objective(s): Cardiac toxicity from thoracic radiation is a significant morbidity in patients who have had surgery for non-small cell lung cancer (NSCLC). Proton therapy has been shown to reduce the mean cardiac dose in patients with NSCLC. Consequently, proton therapy is expected to reduce cardiac toxicity among lung cancer survivors. We report early clinical outcomes of patients with NSCLC treated with surgery and postoperative proton therapy. Materials/Methods: Seven patients with NSCLC who underwent surgical resection and postoperative proton radiation therapy were enrolled in an outcomes tracking protocol. They were prospectively evaluated weekly during treatment and then every 3 months with computed tomography. Toxicities were assessed with the Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. Five patients had stage III NSCLC and 2 patients had stage II NSCLC. One patient had N0 nodal status, 2 patients had N1, and 4 patients had N2. Five patients had a lobectomy and 2 patients had a wedge resection. Two patients had R0 resections, 1 had R1 resections, and 3 had R2 resections. The radiation dose ranged from 50 Gy (RBE) to 74 Gy (RBE). For R0 and R1 resections, radiation fields treated the bronchial stump and involved and adjacent mediastinal lymph node stations according to the Lung ART trial recommendations. Patients with an R2 resection were treated with involved fields to the gross disease. Time from surgical resection to radiation therapy ranged from 2 to 8 months. Five patients received chemotherapy. Results: Median follow-up was 22 months for all patients (range, 848 months). Five patients are alive and free of disease and 4 are more than 2 years out from treatment. Two patients died, one from intercurrent disease 28 months following treatment and the other from disease progression 4 years following treatment. The patient who recurred did so locally and regionally 17 months following treatment. One patient experienced a grade 3 toxicity with recurrent pleural effusion requiring pleurodesis. Two patients had grade 2 pulmonary toxicities and 2 patients had grade 2 gastrointestinal toxicities. Conclusion: This is the first report of postoperative proton therapy in the management of NSCLC. Postoperative proton therapy for NSCLC has acceptable disease control and toxicity. Larger patient cohorts and longer follow-up are needed to confirm the clinical benefits of using proton therapy in this cohort.
Author Disclosure: R.L. Deraniyagala: None. B.S. Hoppe: None. C.G. Morris: None. D.C. Pham: None. H.J. D’Agostino: None. A. Bajwa: None. S. Flampouri: None. S.N. Huh: None. R. Nichols: None.
3045 Prognostic Factors and Outcome After SBRT for Stage I Non-Small Cell Lung Cancer (NSCLC) Using Different Fractionation Regimens From 2007 to 2013 H. Yoon,1 S. Kim,2 J. Yang,3 H. Chen,4 I. Hu,1 B.S. Kim,1 T. Bilfinger,5 R. Matthews,6 D. Franceschi,6 W. Moore,6 A. Stessin,1 and S. Ryu7; 1Stony Brook University, Department of Radiation Oncology, Stony Brook, NY, 2 Kyungpook National University, Daegu, South Korea, 3Stony Brook University, Department of Preventive Medicine, Stony Brook, NY, 4Stony Brook University, Department of Applied Mathematics and Statistics, Stony Brook, NY, 5Stony Brook University, Department of Surgery, Division of Cardiothoracic Surgery, Stony Brook, NY, 6Stony Brook University, Department of Radiology, Stony Brook, NY, 7Stony Brook University, Stony Brook, NY Purpose/Objective(s): The purpose of this study was to report our clinical outcome with SBRT treatment for stage I NSCLC. We also evaluated prognostic factors for local recurrence or overall survival after SBRT in these patients. Materials/Methods: We conducted a retrospective review of 149 patients who underwent SBRT for pathologically diagnosed stage I NSCLC from May 2007 to December 2013. Different dose regimens were used as general practice recommendations changed over time; 52 patients with 20Gy x3 (BEDZ180), 47 patients with 18Gy x3 (BEDZ151), 32 patients with 12Gy x4 (BEDZ105), 9 patients with 10Gy x4 (BEDZ80), 6 patients with 11Gy x4 (BEDZ92), and 3 patients with 15Gy x3 (BEDZ112). Local recurrence rate and overall survival were examined. Results: Median follow up for this cohort was 2 years. Median survival was 4.5 years. The 2 year local control rate was 97.1%. There were 5 local failures, 20 regional failures (13%), and 7 (4.6%) cases of distant metastases. Stage T2N0 (vs. T1N0) was associated with higher local recurrence (p<0.05), while there was a trend towards higher local recurrence with squamous type (vs. adenocarcinoma or other, pZ0.05). Squamous type was also associated with worse survival (p<0.05). Age (>70 at diagnosis), and gender were not associated with local recurrence or survival. Stage was not associated with survival. The dose regimen of 20Gy x3 was associated with significantly higher (p<0.05) mortality (44%) over other dose regimens of 18Gy x3 or 12Gy x4 (10-18%). The cause of this difference could not be identified, although most of these deaths were secondary to comorbidities unrelated to treatment toxicity. Conclusion: SBRT continues to be an effective treatment for inoperable early-stage non-small cell lung cancer, with good local control at our institution. However, there were more regional and distant failures than local failures. Stage T2N0 (vs. T1N0) was associated with higher local recurrence. Thorough staging workup at diagnosis and long-term followup with imaging after treatment are required, to determine the accurate pattern of failure. Squamous type was associated with higher local recurrence and mortality than other types in our experience. Higher mortality occurred with higher BED fractionation, although most of these deaths were not attributed to treatment toxicity. Author Disclosure: H. Yoon: None. S. Kim: None. J. Yang: None. H. Chen: None. I. Hu: None. B. Kim: None. T. Bilfinger: None. R. Matthews: None. D. Franceschi: None. W. Moore: None. A. Stessin: None. S. Ryu: None.
3046 Comparative Outcomes of Stereotactic Ablative Radiation Therapy (SABR) as Salvage for Parenchymal Lung Recurrences Following Initial Curative Surgery Versus De-novo SABR M.H. Bertke, N.H. Bhatt, M.E. Hatch, M. Bousamra, V. Van Berkel, and N.E. Dunlap; University of Louisville School of Medicine, Louisville, KY
Volume 93 Number 3S Supplement 2015 between primary (8%) and recurrent (48%) lesions with log rank analysis showing p-value of 0.03. Twenty-four percent of patients failed distally at 3-years, with similar failure rates among primary and recurrent subsets. Analysis of toxicity revealed no grade 4 or 5 events. Three grade 3 events were reported, consisting of rib fracture, pneumonitis, and pleural effusion. Grade 2 toxicity occurred in 10 patients, including dyspnea (1), chest wall pain (2), pneumonitis (4), rib fracture (1), and cough (2). Conclusion: Moderate prescription dosing, treated once weekly offers acceptable local control rates for centrally located tumors including recurrent mediastinal and hilar lymph nodes. Toxicity was minimal with a majority of patients experiencing no treatment related adverse events. Author Disclosure: J.R. Bowers: None. M. Richardson: None. K.M. Spencer: None. J. Contreras: None. S. Francis: None. N.R. Bennion: None. H. Lomas: None. J.M. Larner: None. R. Kersh: None.
3044 Postoperative Proton Therapy for Resected Non-Small Cell Lung Cancer R.L. Deraniyagala,1 B.S. Hoppe,1 C.G. Morris,2 D.C. Pham,3 H.J. D’Agostino,4 A. Bajwa,3 S. Flampouri,1 S.N. Huh,1 and R.C. Nichols, Jr1; 1University of Florida Health Proton Therapy Institute, Jacksonville, FL, 2University of Florida, Gainesville, FL, 3Department of Medicine, University of Florida, Jacksonville, FL, 4Department of Surgery, University of Florida, Jacksonville, FL Purpose/Objective(s): Cardiac toxicity from thoracic radiation is a significant morbidity in patients who have had surgery for non-small cell lung cancer (NSCLC). Proton therapy has been shown to reduce the mean cardiac dose in patients with NSCLC. Consequently, proton therapy is expected to reduce cardiac toxicity among lung cancer survivors. We report early clinical outcomes of patients with NSCLC treated with surgery and postoperative proton therapy. Materials/Methods: Seven patients with NSCLC who underwent surgical resection and postoperative proton radiation therapy were enrolled in an outcomes tracking protocol. They were prospectively evaluated weekly during treatment and then every 3 months with computed tomography. Toxicities were assessed with the Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. Five patients had stage III NSCLC and 2 patients had stage II NSCLC. One patient had N0 nodal status, 2 patients had N1, and 4 patients had N2. Five patients had a lobectomy and 2 patients had a wedge resection. Two patients had R0 resections, 1 had R1 resections, and 3 had R2 resections. The radiation dose ranged from 50 Gy (RBE) to 74 Gy (RBE). For R0 and R1 resections, radiation fields treated the bronchial stump and involved and adjacent mediastinal lymph node stations according to the Lung ART trial recommendations. Patients with an R2 resection were treated with involved fields to the gross disease. Time from surgical resection to radiation therapy ranged from 2 to 8 months. Five patients received chemotherapy. Results: Median follow-up was 22 months for all patients (range, 848 months). Five patients are alive and free of disease and 4 are more than 2 years out from treatment. Two patients died, one from intercurrent disease 28 months following treatment and the other from disease progression 4 years following treatment. The patient who recurred did so locally and regionally 17 months following treatment. One patient experienced a grade 3 toxicity with recurrent pleural effusion requiring pleurodesis. Two patients had grade 2 pulmonary toxicities and 2 patients had grade 2 gastrointestinal toxicities. Conclusion: This is the first report of postoperative proton therapy in the management of NSCLC. Postoperative proton therapy for NSCLC has acceptable disease control and toxicity. Larger patient cohorts and longer follow-up are needed to confirm the clinical benefits of using proton therapy in this cohort.
Author Disclosure: R.L. Deraniyagala: None. B.S. Hoppe: None. C.G. Morris: None. D.C. Pham: None. H.J. D’Agostino: None. A. Bajwa: None. S. Flampouri: None. S.N. Huh: None. R. Nichols: None.
3045 Prognostic Factors and Outcome After SBRT for Stage I Non-Small Cell Lung Cancer (NSCLC) Using Different Fractionation Regimens From 2007 to 2013 H. Yoon,1 S. Kim,2 J. Yang,3 H. Chen,4 I. Hu,1 B.S. Kim,1 T. Bilfinger,5 R. Matthews,6 D. Franceschi,6 W. Moore,6 A. Stessin,1 and S. Ryu7; 1Stony Brook University, Department of Radiation Oncology, Stony Brook, NY, 2 Kyungpook National University, Daegu, South Korea, 3Stony Brook University, Department of Preventive Medicine, Stony Brook, NY, 4Stony Brook University, Department of Applied Mathematics and Statistics, Stony Brook, NY, 5Stony Brook University, Department of Surgery, Division of Cardiothoracic Surgery, Stony Brook, NY, 6Stony Brook University, Department of Radiology, Stony Brook, NY, 7Stony Brook University, Stony Brook, NY Purpose/Objective(s): The purpose of this study was to report our clinical outcome with SBRT treatment for stage I NSCLC. We also evaluated prognostic factors for local recurrence or overall survival after SBRT in these patients. Materials/Methods: We conducted a retrospective review of 149 patients who underwent SBRT for pathologically diagnosed stage I NSCLC from May 2007 to December 2013. Different dose regimens were used as general practice recommendations changed over time; 52 patients with 20Gy x3 (BEDZ180), 47 patients with 18Gy x3 (BEDZ151), 32 patients with 12Gy x4 (BEDZ105), 9 patients with 10Gy x4 (BEDZ80), 6 patients with 11Gy x4 (BEDZ92), and 3 patients with 15Gy x3 (BEDZ112). Local recurrence rate and overall survival were examined. Results: Median follow up for this cohort was 2 years. Median survival was 4.5 years. The 2 year local control rate was 97.1%. There were 5 local failures, 20 regional failures (13%), and 7 (4.6%) cases of distant metastases. Stage T2N0 (vs. T1N0) was associated with higher local recurrence (p<0.05), while there was a trend towards higher local recurrence with squamous type (vs. adenocarcinoma or other, pZ0.05). Squamous type was also associated with worse survival (p<0.05). Age (>70 at diagnosis), and gender were not associated with local recurrence or survival. Stage was not associated with survival. The dose regimen of 20Gy x3 was associated with significantly higher (p<0.05) mortality (44%) over other dose regimens of 18Gy x3 or 12Gy x4 (10-18%). The cause of this difference could not be identified, although most of these deaths were secondary to comorbidities unrelated to treatment toxicity. Conclusion: SBRT continues to be an effective treatment for inoperable early-stage non-small cell lung cancer, with good local control at our institution. However, there were more regional and distant failures than local failures. Stage T2N0 (vs. T1N0) was associated with higher local recurrence. Thorough staging workup at diagnosis and long-term followup with imaging after treatment are required, to determine the accurate pattern of failure. Squamous type was associated with higher local recurrence and mortality than other types in our experience. Higher mortality occurred with higher BED fractionation, although most of these deaths were not attributed to treatment toxicity. Author Disclosure: H. Yoon: None. S. Kim: None. J. Yang: None. H. Chen: None. I. Hu: None. B. Kim: None. T. Bilfinger: None. R. Matthews: None. D. Franceschi: None. W. Moore: None. A. Stessin: None. S. Ryu: None.
3046 Comparative Outcomes of Stereotactic Ablative Radiation Therapy (SABR) as Salvage for Parenchymal Lung Recurrences Following Initial Curative Surgery Versus De-novo SABR M.H. Bertke, N.H. Bhatt, M.E. Hatch, M. Bousamra, V. Van Berkel, and N.E. Dunlap; University of Louisville School of Medicine, Louisville, KY