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Preliminary Results of Definite Radiation Therapy for Stage II Non-small Cell Lung Cancer
Poster Viewing Abstracts S567
Volume 84 Number 3S Supplement 2012 The Kaplan-Meier product limit method provided estimates of overall and disease-free survival; the log rank test statistic indicated whether stratifications of these estimates by selected prognostic factors were significant. Proportional hazards regression was utilized for multivariate analysis. Fisher’s exact test was used to test contingency tables. Results: With a median follow up of 1.3 years, the median survival was 13 months with a 3- and 5-year Kaplan Meier estimate of overall survival (OS) of 21 and 12%, respectively. On multivariate analysis, age (p< 0.032), marital status (p< 0.003), and gender (p< 0.012), were independent predictors of OS, independent of disease and treatment related variables. Married patients had improved survival compared to single patients with 3 yr rates of 33 vs 10% (p<0.001), and men had inferior survival compared to women 35 vs 13% (pZ0.004). Single men had the worst overall survival 3yr rates of 3%, while married women had the best survival with 3-yr rates of 46%, pZ0.029. Single females and married men had intermediate 3-yr survivals of 25%. When stratified by race, married whites had the best survival followed by married blacks and then single patients with 3 yr survival rates of 40%, 26% and 11% respectively, pZ0.005. Conclusions: In locally advanced NSCLC patients, marital status appears to be an important independent predictor of survival. The exact etiology of this inferior outcome is unclear and needs further clarification however marital status may be a surrogate for better supportive care and compliance. This provides evidence that social interventions have the potential to improve survival. Author Disclosure: E.M. Nichols: None. M. Liriano: None. C.G. Morris: None. W. Burrows: None. R. Battafarano: None. M. Garofalo: None. M. Turner: None. M. Suntharalingam: None. M.J. Edelman: None. S.J. Feigenberg: None.
2927 Invasive Thymoma: Results of Mediastinal and Low-dose Entire Hemithorax Irradiation K. Uchiyama, S. Otsuka, C. Hasizume, C. Sugie, S. Ishikura, and Y. Shibamoto; Nagoya City University Hospital, Department of Radiology, Nagoya, Japan Purpose/Objective(s): Invasive thymoma is a relatively radiosensitive tumor. Radiation therapy plays an important role as an adjuvant treatment after surgery and remains the sole treatment for unresectable cases. The purpose of this study was to evaluate treatment outcome of patients with invasive thymoma undergoing radiation therapy at our institution. Materials/Methods: Between 1987 and 2011, 79 patients with thymoma underwent thoracic radiation therapy with (n Z 29) or without platinumbased chemotherapy. Median patient age was 56 years (range, 21-83). Thirty were men and 49 were women. In principle, mediastinal radiation therapy (MRT) with 30-40 Gy was administered at 2-Gy daily fractions following surgery for Masaoka stage II tumors. For Masaoka stage III tumors with minimal extracapsular invasion, MRT with 40-46 Gy was given, and when macroscopic residual lesions were present, MRT dose was 46-50 Gy. For unresectable tumors, 50-64 Gy MRT was delivered. In stage IVa patients with pleural dissemination, low-dose entire hemithorax radiation therapy (EHRT) with 11.2-16 Gy in 7-10 fractions was administered after surgical removal of disseminated lesions, in addition to MRT. Assessed parameters were age, sex, stage, resectability, treatment modality, survival, and toxicity. Overall survival (OS), cause-specific survival (CSS), and local control (LC) rates were estimated by the Kaplan-Meier method and toxicities were evaluated with the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Results: The median follow-up period for living patients was 103 months. For all 79 patients, 5-year OS, CSS, and LC rates were 79%, 84%, and 80%, respectively. The rates were, respectively, 95%, 100%, and 94% for stage I or II patients, 85%, 89% and 86% for stage III patients, 66%, 69% and 59% for stage IVa, and 64%, 70% and 67% for stage IVb. The 5-year OS rate was 80% after total resection, 96% for patients with a microscopic residual lesion, 79% for those with a macroscopic residual lesion and 41% for patients with an unresectable tumor. In inoperable cases, the 5-year local control and dissemination control rates were 91% and 56%,
respectively. The 5-year pleural dissemination control rate after EHRT was 74%. Grade 3 or higher radiation pneumonitis were observed in only 3 patients (4%), but grade 5 radiation pneumonitis occurred in 1. Seventeen patients developed grade 2 pneumonitis and 18 had grade 1 pneumonitis. Both Masaoka stage and tumor resectability were associated with prognosis (P Z 0.005 and 0.001, respectively). Conclusions: MRT and EHRT for invasive thymoma appeared to contribute to improvement of OS, CSS, and LC rates with acceptable toxicity. Unresectable cases had a high LC rate, but dissemination control and OS rates were unsatisfactory. Inoperable patients appear increasing, so further improvement of combination treatment is desirable. Author Disclosure: K. Uchiyama: None. S. Otsuka: None. C. Hasizume: None. C. Sugie: None. S. Ishikura: None. Y. Shibamoto: None.
2928 Preliminary Results of Definite Radiation Therapy for Stage II Nonsmall Cell Lung Cancer R. Mikami, H. Nakayama, S. Nogi, Y. Tajima, M. Okubo, N. Kanesaka, S. Sugahara, and K. Tokuuye; Tokyo Medical University, Tokyo, Japan Purpose/Objective(s): The outcome of patients with stage II non-small cell lung cancer (NSCLC) who underwent definite radiation therapy has not been published enough. We aimed to retrospectively investigate the outcomes of patients with stage II NSCLC who underwent definitive radiation therapy. Materials/Methods: Between June 2001 and November 2009, 25 consecutive patients with clinical stage II NSCLC who underwent definite radiation therapy were assessed. The median age was 71 years, ranging from 50 to 89. According to the 7th edition of American joint committee on cancer, the number of patients of clinical stage IIA and IIB were respective eight and 17. Twenty-three patients of the 25 were medically inoperable and the remaining two patients refused surgery. Of the 23, 12 patients had pulmonary disease, five cardiovascular disease, five diabetes mellitus and one another cancer. All patients were histologically confirmed as NSCLC; 13 patients had squamous cell carcinoma, nine adenocarcinoma, two nonsmall cell carcinoma and one large cell neuroendocrine tumor. Median radiation dose of 60 Gy (60 - 70) in 30 sessions (30 - 35) were delivered with a daily 2 Gy using 3-D conformal radiation therapy. Irradiation to the elective lymph node was omitted from 2009. Ten and six patients underwent chemoradiation therapy concurrently or sequentially, respectively, and nine patients underwent radiation therapy alone. Results: Median follow-up period was 25 months, ranging from nine to 73. Clinically complete response was observed in 48% of the patients, partial response 36%, stable disease 8% and progressive disease 8%. Two-year local progression free survival, progression free survival and overall survival were achieved in 86.9% (95% confidence interval [CI]; 72.9 to 100.1%), 79.0% (95% CI; 62.5 to 95.4%) and 80.4% (95% CI; 62.9 to 97.9%), respectively. Concerning the initial relapse sites, six patients had local recurrence, one mediastinum lymph node and one bone metastases. No factors, such as clinical stage, addition of chemotherapy, performance status, omission of elective lymph node irradiation and age, were statistically significant for overall survival. None had Grade 3 toxicities or more. Conclusions: Two-year overall survival of radiation therapy for patients with stage II NSCLC appears comparable with that of surgery. Further study of definitive radiation therapy for stage II NSCLC was warranted. Author Disclosure: R. Mikami: None. H. Nakayama: None. S. Nogi: None. Y. Tajima: None. M. Okubo: None. N. Kanesaka: None. S. Sugahara: None. K. Tokuuye: None.
2929 Intermediate Hypofractionated Radiation Therapy for Lung Parenchymal Tumor L. Jeongshim; Severance Hospital, Seoul, Korea Purpose/Objective(s): The aim of this study was to evaluate the tumor control of intermediate hypofractionated radiation therapy (IHRT) for patients with parenchymal lung tumor.
Volume 84 Number 3S Supplement 2012 The Kaplan-Meier product limit method provided estimates of overall and disease-free survival; the log rank test statistic indicated whether stratifications of these estimates by selected prognostic factors were significant. Proportional hazards regression was utilized for multivariate analysis. Fisher’s exact test was used to test contingency tables. Results: With a median follow up of 1.3 years, the median survival was 13 months with a 3- and 5-year Kaplan Meier estimate of overall survival (OS) of 21 and 12%, respectively. On multivariate analysis, age (p< 0.032), marital status (p< 0.003), and gender (p< 0.012), were independent predictors of OS, independent of disease and treatment related variables. Married patients had improved survival compared to single patients with 3 yr rates of 33 vs 10% (p<0.001), and men had inferior survival compared to women 35 vs 13% (pZ0.004). Single men had the worst overall survival 3yr rates of 3%, while married women had the best survival with 3-yr rates of 46%, pZ0.029. Single females and married men had intermediate 3-yr survivals of 25%. When stratified by race, married whites had the best survival followed by married blacks and then single patients with 3 yr survival rates of 40%, 26% and 11% respectively, pZ0.005. Conclusions: In locally advanced NSCLC patients, marital status appears to be an important independent predictor of survival. The exact etiology of this inferior outcome is unclear and needs further clarification however marital status may be a surrogate for better supportive care and compliance. This provides evidence that social interventions have the potential to improve survival. Author Disclosure: E.M. Nichols: None. M. Liriano: None. C.G. Morris: None. W. Burrows: None. R. Battafarano: None. M. Garofalo: None. M. Turner: None. M. Suntharalingam: None. M.J. Edelman: None. S.J. Feigenberg: None.
2927 Invasive Thymoma: Results of Mediastinal and Low-dose Entire Hemithorax Irradiation K. Uchiyama, S. Otsuka, C. Hasizume, C. Sugie, S. Ishikura, and Y. Shibamoto; Nagoya City University Hospital, Department of Radiology, Nagoya, Japan Purpose/Objective(s): Invasive thymoma is a relatively radiosensitive tumor. Radiation therapy plays an important role as an adjuvant treatment after surgery and remains the sole treatment for unresectable cases. The purpose of this study was to evaluate treatment outcome of patients with invasive thymoma undergoing radiation therapy at our institution. Materials/Methods: Between 1987 and 2011, 79 patients with thymoma underwent thoracic radiation therapy with (n Z 29) or without platinumbased chemotherapy. Median patient age was 56 years (range, 21-83). Thirty were men and 49 were women. In principle, mediastinal radiation therapy (MRT) with 30-40 Gy was administered at 2-Gy daily fractions following surgery for Masaoka stage II tumors. For Masaoka stage III tumors with minimal extracapsular invasion, MRT with 40-46 Gy was given, and when macroscopic residual lesions were present, MRT dose was 46-50 Gy. For unresectable tumors, 50-64 Gy MRT was delivered. In stage IVa patients with pleural dissemination, low-dose entire hemithorax radiation therapy (EHRT) with 11.2-16 Gy in 7-10 fractions was administered after surgical removal of disseminated lesions, in addition to MRT. Assessed parameters were age, sex, stage, resectability, treatment modality, survival, and toxicity. Overall survival (OS), cause-specific survival (CSS), and local control (LC) rates were estimated by the Kaplan-Meier method and toxicities were evaluated with the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Results: The median follow-up period for living patients was 103 months. For all 79 patients, 5-year OS, CSS, and LC rates were 79%, 84%, and 80%, respectively. The rates were, respectively, 95%, 100%, and 94% for stage I or II patients, 85%, 89% and 86% for stage III patients, 66%, 69% and 59% for stage IVa, and 64%, 70% and 67% for stage IVb. The 5-year OS rate was 80% after total resection, 96% for patients with a microscopic residual lesion, 79% for those with a macroscopic residual lesion and 41% for patients with an unresectable tumor. In inoperable cases, the 5-year local control and dissemination control rates were 91% and 56%,
respectively. The 5-year pleural dissemination control rate after EHRT was 74%. Grade 3 or higher radiation pneumonitis were observed in only 3 patients (4%), but grade 5 radiation pneumonitis occurred in 1. Seventeen patients developed grade 2 pneumonitis and 18 had grade 1 pneumonitis. Both Masaoka stage and tumor resectability were associated with prognosis (P Z 0.005 and 0.001, respectively). Conclusions: MRT and EHRT for invasive thymoma appeared to contribute to improvement of OS, CSS, and LC rates with acceptable toxicity. Unresectable cases had a high LC rate, but dissemination control and OS rates were unsatisfactory. Inoperable patients appear increasing, so further improvement of combination treatment is desirable. Author Disclosure: K. Uchiyama: None. S. Otsuka: None. C. Hasizume: None. C. Sugie: None. S. Ishikura: None. Y. Shibamoto: None.
2928 Preliminary Results of Definite Radiation Therapy for Stage II Nonsmall Cell Lung Cancer R. Mikami, H. Nakayama, S. Nogi, Y. Tajima, M. Okubo, N. Kanesaka, S. Sugahara, and K. Tokuuye; Tokyo Medical University, Tokyo, Japan Purpose/Objective(s): The outcome of patients with stage II non-small cell lung cancer (NSCLC) who underwent definite radiation therapy has not been published enough. We aimed to retrospectively investigate the outcomes of patients with stage II NSCLC who underwent definitive radiation therapy. Materials/Methods: Between June 2001 and November 2009, 25 consecutive patients with clinical stage II NSCLC who underwent definite radiation therapy were assessed. The median age was 71 years, ranging from 50 to 89. According to the 7th edition of American joint committee on cancer, the number of patients of clinical stage IIA and IIB were respective eight and 17. Twenty-three patients of the 25 were medically inoperable and the remaining two patients refused surgery. Of the 23, 12 patients had pulmonary disease, five cardiovascular disease, five diabetes mellitus and one another cancer. All patients were histologically confirmed as NSCLC; 13 patients had squamous cell carcinoma, nine adenocarcinoma, two nonsmall cell carcinoma and one large cell neuroendocrine tumor. Median radiation dose of 60 Gy (60 - 70) in 30 sessions (30 - 35) were delivered with a daily 2 Gy using 3-D conformal radiation therapy. Irradiation to the elective lymph node was omitted from 2009. Ten and six patients underwent chemoradiation therapy concurrently or sequentially, respectively, and nine patients underwent radiation therapy alone. Results: Median follow-up period was 25 months, ranging from nine to 73. Clinically complete response was observed in 48% of the patients, partial response 36%, stable disease 8% and progressive disease 8%. Two-year local progression free survival, progression free survival and overall survival were achieved in 86.9% (95% confidence interval [CI]; 72.9 to 100.1%), 79.0% (95% CI; 62.5 to 95.4%) and 80.4% (95% CI; 62.9 to 97.9%), respectively. Concerning the initial relapse sites, six patients had local recurrence, one mediastinum lymph node and one bone metastases. No factors, such as clinical stage, addition of chemotherapy, performance status, omission of elective lymph node irradiation and age, were statistically significant for overall survival. None had Grade 3 toxicities or more. Conclusions: Two-year overall survival of radiation therapy for patients with stage II NSCLC appears comparable with that of surgery. Further study of definitive radiation therapy for stage II NSCLC was warranted. Author Disclosure: R. Mikami: None. H. Nakayama: None. S. Nogi: None. Y. Tajima: None. M. Okubo: None. N. Kanesaka: None. S. Sugahara: None. K. Tokuuye: None.
2929 Intermediate Hypofractionated Radiation Therapy for Lung Parenchymal Tumor L. Jeongshim; Severance Hospital, Seoul, Korea Purpose/Objective(s): The aim of this study was to evaluate the tumor control of intermediate hypofractionated radiation therapy (IHRT) for patients with parenchymal lung tumor.