- Email: [email protected]
Pretreatment Anemia Portends Poor Outcomes in Stage I Non-Small Cell Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy
Poster Viewing E427
Volume 96 Number 2S Supplement 2016
3051 Location, Location, Location: Lower Lobe Stage I Non-Small Cell Lung Cancer Treated With Stereotactic Body Radiation Therapy Are Associated With Poor Outcomes N. Shaverdian,1 D. Veruttipong,1 J. Wang,1 P.A. Kupelian,2 M.L. Steinberg,2 and P. Lee1; 1University of California, Los Angeles, Los Angeles, CA, 2University of California, Los Angeles- David Geffen School of Medicine, Los Angeles, CA Purpose/Objective(s): The lung is a heterogeneous organ with relative over-perfusion of the lung bases as the result of gravity. Surgical series have found lower lobe primary tumors to be associated with poor outcomes and with upstaging after surgery. We sought to determine if a lower lobe primary tumor location was associated with poor outcomes in the setting of stage I non-small-cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). Materials/Methods: 115 consecutive stage I NSCLC patients with 122 separate primaries treated at a single institution with SBRT for curative intent from 2009 -2014 were retrospectively analyzed. The SBRT regimen was 54Gy in 3 fractions for peripheral tumors and 50Gy in 4 fractions for central tumors. Patients with multiple primary tumors in upper and lower lobe locations were excluded. Primary tumors in the right and left lower lobes were compared against tumors in all other locations to determine if a lower lobe location was associated with worse local, regional and distant control, as well as a worse disease-free and overall survival (per RTOG 0236). Survival rates were estimated with Kaplan-Meier analysis and multivariate analysis was completed adjusting for age, KPS, T-stage, and radiation dose using the Cox proportional hazards model. Results: 122 cases of cases of early stage NSCLC treated with SBRT were evaluated with a median follow up of 28.6 months. The average patient age was 77 years and the majority of patients had a KPS score of either 80 or 90 (85%), T1a disease (56%) and peripherally located (90%) tumors treated to 54Gy in three fractions. Thirty-seven percent of all tumors were located in the right or left lower lobes. There were no significant differences between the distribution of age, T-stage, KPS and radiation dose between patients with upper and middle lobe primary tumors compared to those with lower lobe tumors. The three-year local, regional and distant control rates were 96%, 86%, and 89%, respectively. The three-year overall survival and disease-free survival rates were 75% and 84%, respectively. On multivariate analysis, lower lobe tumors were associated with poor overall survival (hazard ratio [HR] Z 2.33, p Z 0.04) and poor disease-free survival (HR Z 2.78, p Z 0.04). A lower lobe tumor location was not predictive for poor local, regional and distant control (p Z 0.30, p Z 0.15, p Z 0.64, respectively). The three-year overall survival rate for patients with lower lobe primaries was 63% vs. 82% in patients with nonlower lobe primaries (p Z 0.01). Additionally, the three-year disease-free survival for patients with lower lobe primaries was 75% vs. 89% in patients with non-lower lobe primaries (p Z 0.04). Conclusion: Lower lobe stage I NSCLC tumors treated with SBRT appear to be associated with poor disease-free and overall survival. Author Disclosure: N. Shaverdian: None. D. Veruttipong: None. J. Wang: None. P.A. Kupelian: None. M.L. Steinberg: None. P. Lee: None.
3052 Pretreatment Anemia Portends Poor Outcomes in Stage I Non-Small Cell Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy N. Shaverdian,1 D. Veruttipong,1 J. Wang,1 P.A. Kupelian,2 M.L. Steinberg,2 and P. Lee1; 1University of California, Los Angeles, Los Angeles, CA, 2University of California, Los Angeles- David Geffen School of Medicine, Los Angeles, CA Purpose/Objective(s): Anemia is an independent prognostic factor for poor outcomes in many solid malignancies, but has not yet been reported as a prognostic indicator in the setting of early stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT).
We thus determined if pretreatment anemia was associated with poor outcomes in this setting. Materials/Methods: From February 2009 to January 2014, consecutive Stage I NSCLC patients treated at a single institution with SBRT for curative intent were retrospectively analyzed. The SBRT regimen was 54Gy in 3 fractions for peripheral tumors and 50Gy in 4 fractions for central tumors. Pretreatment hemoglobin levels measured from blood draws within 8 weeks of the first fraction of SBRT were evaluated to determine its association with local, regional and distant control per RTOG 0236 as well as disease-free and overall survival. Survival rates were estimated with Kaplan-Meier analysis and multivariate analysis was completed adjusting for age, T-stage and radiation dose using the Cox proportional hazards model. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal pretreatment hemoglobin level that best predicted for poor regional control and disease-free survival. Results: 147 cases of early stage NSCLC treated with SBRT were evaluated with a median follow up of 28.9 months. The majority of patients had a KPS score of either 80 or 90 (85%), T1a disease (56%) and peripherally located (89%) tumors treated to 54Gy in three fractions. The three-year local, regional and distant control rates were 95%, 87%, and 89%, respectively. The three-year overall survival and disease-free survival rates were 75% and 83%, respectively. On multivariate analysis, a lower pretreatment hemoglobin predicted for poor regional control (hazard ratio [HR] Z 1.79, p Z 0.03), poor disease-free survival (HR Z 1.61, p Z 0.04), and for poor overall survival (HR Z 1.49, p Z 0.05). Pretreatment hemoglobin levels were not predictive of poor local or distant control. ROC analysis found that a pretreatment hemoglobin <12.2 g/dL optimally predicted for regional control and poor disease-free survival. Three-year regional control for patients with hemoglobin 12.2 g/dL was 95% vs. 75% in patients with a hemoglobin <12.2 g/dL (p Z 0.02). Additionally, the three-year disease-free survival for patients with hemoglobin 12.2 g/ dL was 94% vs. 70% in patients with a hemoglobin <12.2 g/dL (p < 0.01). Conclusion: In the setting of SBRT for early stage NSCLC, pretreatment anemia appears to predict for aggressive disease with poor overall survival and increased regional failures. Author Disclosure: N. Shaverdian: None. D. Veruttipong: None. J. Wang: None. P.A. Kupelian: None. M.L. Steinberg: None. P. Lee: None.
3053 Treatment for Unresectable Masaoka Stage III Thymic CarcinomadA Report From a Single Center Y.R. Zhai,1 W. Ji,2 Z. Hui,3 X. Wang,3 J. Liang,4 J. Lv,5 H. Zhang,4 Q. Feng,4 Z. Zhou,3 C. Dongfu,2 and L. Wang6; 1Cancer Hospital, Chinese Academy of Medical Sciences, Peking, China, 2Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China, 3Department of Radiation Oncology, Cancer Institute & Hospital, Chinese Academic of Medical Sciences (CIH-CAMS), Peking Union Medical College (PUMC), Beijing, China, 4Department of Radiation Oncology, Cancer Institute & Hospital, Chinese Academic of Medical Sciences (CIH-CAMS), Peking Union Medical College (PUMC), Beijing 100021, Beijing, China, 5Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Beijing, China, 6Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking, China Purpose/Objective(s): Thymic carcinoma is typically characterized by more extensive local invasion, more frequent metastasis and worse prognosis, compared with other subtypes of thymoma. The majority of patients with thymic carcinoma were diagnosed as stage III-IV, which obtained few opportunities of total resection. For this group of patients, 2 therapeutic methods could be selected, debulking surgery plus postoperative radiation therapy and radiation alone. Some previous data suggested an obvious difference in overall survival (OS) between the patients who received the 2 different therapies in thymoma, but little evidence was published in thymic carcinoma and the sporadic incidence has precluded the disposal of randomized clinical trials. We designed this retrospective research to approach this question. Materials/Methods: A single center retrospective study of patients histologically diagnosed thymic carcinoma with disease of Masaoka stage III
Volume 96 Number 2S Supplement 2016
3051 Location, Location, Location: Lower Lobe Stage I Non-Small Cell Lung Cancer Treated With Stereotactic Body Radiation Therapy Are Associated With Poor Outcomes N. Shaverdian,1 D. Veruttipong,1 J. Wang,1 P.A. Kupelian,2 M.L. Steinberg,2 and P. Lee1; 1University of California, Los Angeles, Los Angeles, CA, 2University of California, Los Angeles- David Geffen School of Medicine, Los Angeles, CA Purpose/Objective(s): The lung is a heterogeneous organ with relative over-perfusion of the lung bases as the result of gravity. Surgical series have found lower lobe primary tumors to be associated with poor outcomes and with upstaging after surgery. We sought to determine if a lower lobe primary tumor location was associated with poor outcomes in the setting of stage I non-small-cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). Materials/Methods: 115 consecutive stage I NSCLC patients with 122 separate primaries treated at a single institution with SBRT for curative intent from 2009 -2014 were retrospectively analyzed. The SBRT regimen was 54Gy in 3 fractions for peripheral tumors and 50Gy in 4 fractions for central tumors. Patients with multiple primary tumors in upper and lower lobe locations were excluded. Primary tumors in the right and left lower lobes were compared against tumors in all other locations to determine if a lower lobe location was associated with worse local, regional and distant control, as well as a worse disease-free and overall survival (per RTOG 0236). Survival rates were estimated with Kaplan-Meier analysis and multivariate analysis was completed adjusting for age, KPS, T-stage, and radiation dose using the Cox proportional hazards model. Results: 122 cases of cases of early stage NSCLC treated with SBRT were evaluated with a median follow up of 28.6 months. The average patient age was 77 years and the majority of patients had a KPS score of either 80 or 90 (85%), T1a disease (56%) and peripherally located (90%) tumors treated to 54Gy in three fractions. Thirty-seven percent of all tumors were located in the right or left lower lobes. There were no significant differences between the distribution of age, T-stage, KPS and radiation dose between patients with upper and middle lobe primary tumors compared to those with lower lobe tumors. The three-year local, regional and distant control rates were 96%, 86%, and 89%, respectively. The three-year overall survival and disease-free survival rates were 75% and 84%, respectively. On multivariate analysis, lower lobe tumors were associated with poor overall survival (hazard ratio [HR] Z 2.33, p Z 0.04) and poor disease-free survival (HR Z 2.78, p Z 0.04). A lower lobe tumor location was not predictive for poor local, regional and distant control (p Z 0.30, p Z 0.15, p Z 0.64, respectively). The three-year overall survival rate for patients with lower lobe primaries was 63% vs. 82% in patients with nonlower lobe primaries (p Z 0.01). Additionally, the three-year disease-free survival for patients with lower lobe primaries was 75% vs. 89% in patients with non-lower lobe primaries (p Z 0.04). Conclusion: Lower lobe stage I NSCLC tumors treated with SBRT appear to be associated with poor disease-free and overall survival. Author Disclosure: N. Shaverdian: None. D. Veruttipong: None. J. Wang: None. P.A. Kupelian: None. M.L. Steinberg: None. P. Lee: None.
3052 Pretreatment Anemia Portends Poor Outcomes in Stage I Non-Small Cell Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy N. Shaverdian,1 D. Veruttipong,1 J. Wang,1 P.A. Kupelian,2 M.L. Steinberg,2 and P. Lee1; 1University of California, Los Angeles, Los Angeles, CA, 2University of California, Los Angeles- David Geffen School of Medicine, Los Angeles, CA Purpose/Objective(s): Anemia is an independent prognostic factor for poor outcomes in many solid malignancies, but has not yet been reported as a prognostic indicator in the setting of early stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT).
We thus determined if pretreatment anemia was associated with poor outcomes in this setting. Materials/Methods: From February 2009 to January 2014, consecutive Stage I NSCLC patients treated at a single institution with SBRT for curative intent were retrospectively analyzed. The SBRT regimen was 54Gy in 3 fractions for peripheral tumors and 50Gy in 4 fractions for central tumors. Pretreatment hemoglobin levels measured from blood draws within 8 weeks of the first fraction of SBRT were evaluated to determine its association with local, regional and distant control per RTOG 0236 as well as disease-free and overall survival. Survival rates were estimated with Kaplan-Meier analysis and multivariate analysis was completed adjusting for age, T-stage and radiation dose using the Cox proportional hazards model. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal pretreatment hemoglobin level that best predicted for poor regional control and disease-free survival. Results: 147 cases of early stage NSCLC treated with SBRT were evaluated with a median follow up of 28.9 months. The majority of patients had a KPS score of either 80 or 90 (85%), T1a disease (56%) and peripherally located (89%) tumors treated to 54Gy in three fractions. The three-year local, regional and distant control rates were 95%, 87%, and 89%, respectively. The three-year overall survival and disease-free survival rates were 75% and 83%, respectively. On multivariate analysis, a lower pretreatment hemoglobin predicted for poor regional control (hazard ratio [HR] Z 1.79, p Z 0.03), poor disease-free survival (HR Z 1.61, p Z 0.04), and for poor overall survival (HR Z 1.49, p Z 0.05). Pretreatment hemoglobin levels were not predictive of poor local or distant control. ROC analysis found that a pretreatment hemoglobin <12.2 g/dL optimally predicted for regional control and poor disease-free survival. Three-year regional control for patients with hemoglobin 12.2 g/dL was 95% vs. 75% in patients with a hemoglobin <12.2 g/dL (p Z 0.02). Additionally, the three-year disease-free survival for patients with hemoglobin 12.2 g/ dL was 94% vs. 70% in patients with a hemoglobin <12.2 g/dL (p < 0.01). Conclusion: In the setting of SBRT for early stage NSCLC, pretreatment anemia appears to predict for aggressive disease with poor overall survival and increased regional failures. Author Disclosure: N. Shaverdian: None. D. Veruttipong: None. J. Wang: None. P.A. Kupelian: None. M.L. Steinberg: None. P. Lee: None.
3053 Treatment for Unresectable Masaoka Stage III Thymic CarcinomadA Report From a Single Center Y.R. Zhai,1 W. Ji,2 Z. Hui,3 X. Wang,3 J. Liang,4 J. Lv,5 H. Zhang,4 Q. Feng,4 Z. Zhou,3 C. Dongfu,2 and L. Wang6; 1Cancer Hospital, Chinese Academy of Medical Sciences, Peking, China, 2Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China, 3Department of Radiation Oncology, Cancer Institute & Hospital, Chinese Academic of Medical Sciences (CIH-CAMS), Peking Union Medical College (PUMC), Beijing, China, 4Department of Radiation Oncology, Cancer Institute & Hospital, Chinese Academic of Medical Sciences (CIH-CAMS), Peking Union Medical College (PUMC), Beijing 100021, Beijing, China, 5Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Beijing, China, 6Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Peking, China Purpose/Objective(s): Thymic carcinoma is typically characterized by more extensive local invasion, more frequent metastasis and worse prognosis, compared with other subtypes of thymoma. The majority of patients with thymic carcinoma were diagnosed as stage III-IV, which obtained few opportunities of total resection. For this group of patients, 2 therapeutic methods could be selected, debulking surgery plus postoperative radiation therapy and radiation alone. Some previous data suggested an obvious difference in overall survival (OS) between the patients who received the 2 different therapies in thymoma, but little evidence was published in thymic carcinoma and the sporadic incidence has precluded the disposal of randomized clinical trials. We designed this retrospective research to approach this question. Materials/Methods: A single center retrospective study of patients histologically diagnosed thymic carcinoma with disease of Masaoka stage III