- Email: [email protected]
Pretreatment Factors Influencing Radiation Pneumonitis after Stereotactic Body Radiation Therapy in the Treatment of Lung Cancer
Poster Viewing E459
Volume 99 Number 2S Supplement 2017 not specified. The median dose delivered was 60Gy in 5 fractions (range 48-75Gy). With a median follow-up of 2 years, the 1-year/3-year LC rates of T1 tumor are 96.5%/90.4%, 90.7%/74.5%, and 89.6%/76.8% in the primary, recurrence, and metastases group respectively. For T2 tumor, 1year/3-year LC rates are 73.3%/48.9%, 80%/53.5%, and 100%/0% respectively. Also, 1-year/3year DFS rates of T1 tumor are 91.8%/91.8%, 90.3%/77.4%, and 84.9%/64.8% in the primary, recurrence and metastases respectively. For T2 tumor, 1-year/3year DFS rates are 74.6%/ 74.6%, 83.3%/55.6%, and 100%/0% respectively. 1-year/3year OS rates of T1 tumor are 93.5%/77.5%, 91.5%/65.6%, and 96.0%/68.4% respectively. For T2 tumor, 1-year/3year OS rates are 69.2%/40.4%, 100%/ 75.0%, and 100%/0% respectively. Five year OS including both T1 and T2 tumors is 58.2%, 58.2%, and 24.4% for primary, recurrence and metastases respectively. Conclusion: One year OS for T1 was excellent and was not significantly different among three groups. Also, DFS of the lung metastases was poorest, but it did not affect OS. Five year OS of primary and recurrence tumors were the same. Therefore, early detection of post-operative recurrence and appropriate use of systemic therapies for lung metastases besides SBRT might have possibility for improving overall survivals longer. Author Disclosure: K. Harada: None.
3090 Pretreatment Factors Influencing Radiation Pneumonitis after Stereotactic Body Radiation Therapy in the Treatment of Lung Cancer A. Harris,1 A. Davis,1 K. Stang,2 F. Alite Jr,2 C. Small,2 R. Hutten,2 B. Emami,2 and M.M. Harkenrider2; 1Grand Rapids Medical Education Partners, Grand Rapids, MI, 2Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL Purpose/Objective(s): Radiation pneumonitis is a dose limiting toxicity that impacts the treatment of patients with lung cancer. Factors predictive of symptomatic radiation pneumonitis have been described for many modalities of radiotherapy, but there is limited data describing these factors for stereotactic body radiation therapy (SBRT). We reviewed patient data to assess for pretreatment factors that are predictive of symptomatic radiation pneumonitis for treatment of lung cancer with SBRT. Materials/Methods: Data was collected on 228 patients who were treated with SBRT for either primary or metastatic lung cancer. Patient and tumor factors were analyzed to assess for a potential correlation to the development of symptomatic radiation pneumonitis, defined as CTCAE v4.0 Grade 2. The specific factors analyzed included patient age, KPS, gender, smoking status, pack year smoking history, tumor location, tumor size, tumor histology, number of sites treated and PFT data including pretreatment percent predicted FVC, FEV1, FVC/FEV1, DlCO. Categorical variables were analyzed using Fischer Exact and Chi Squares tests and continuous variables were analyzed using a univariate logistic regression analysis. Results: The median follow-up was 22 months (1-116 months). The overall rate of symptomatic radiation pneumonitis was 21% (NZ40), with no cases of fatal radiation pneumonitis. In comparison between patients that went on to develop radiation pneumonitis and those that did not, there was no statistically significant difference in the age, gender, KPS, smoking status, or pack years smoked. Similarly, there was no difference in the pretreatment percentage of predicted FVC, FEV1, FEV1/FVC, or DlCO. There was no difference in rate of developing radiation pneumonitis as a function of tumor size, tumor histology, or peripheral vs. central location. There was, however, a statistically significant increased rate of developing radiation pneumonitis with treatments to the right lung over the left lung (26% vs 11%,
pZ0.04) as well as with treating multiple lesions over a single lesion (47% vs 18%, pZ0.03). Conclusion: SBRT to the right lung and the treatment of multiple lesions are risk factors for developing radiation pneumonitis after SBRT in the treatment of lung cancer. Further study on ways to prevent development of radiation pneumonitis is required. Author Disclosure: A. Harris: None. A. Davis: None. K. Stang: None. F. Alite: None. C. Small: None. R. Hutten: None. B. Emami: None. M.M. Harkenrider: None.
3091 Increasing Utilization of Stereotactic Radiation Therapy as a Component of Initial Therapy in Metastatic Nonesmall Cell Lung Cancer T.J. Hayman,1 T.J. Bledsoe,1 C. Corso,1 N.H. Lester-Coll,1 H.S.M. Park,2 and R.H. Decker1; 1Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, 2Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT Purpose/Objective(s): Accumulating evidence suggests that definitive local therapy (e.g. surgery or stereotactic radiotherapy [SRT]) may improve outcomes in well-selected patients with metastatic non-small cell lung cancer (NSCLC). The goal of this study was to determine trends in the utilization of aggressive local therapy over time in patients with metastatic NSCLC as well as factors predicting for the use of SRT versus surgery. Materials/Methods: The National Cancer Data Base was queried to identify patients diagnosed with metastatic NSCLC in 2004 - 2014. SRT was defined as 10 fractions of radiotherapy with a biologically equivalent dose (assuming a/bZ10) of 48-180 Gy calculated using the linearquadratic equation. Kaplan-Meier analysis was used to estimate median survival. The surgery group included patients receiving ablation. Univariable analysis was performed using the chi-square test, and multivariable analysis was performed using a logistic regression model. Results: A total of 270,593 patients with metastatic NSCLC were identified, among whom 38,089 patients (14%) were treated with aggressive local therapy. The median overall survival of this cohort receiving local therapy was 9.1 months. The proportion of patients receiving aggressive local therapy increased from 12.1% in 2004 to 16.2% in 2014. Overall, SRT utilization increased from 1.1 % in 2004 to 4.7% in 2014, whereas surgery utilization remained relatively stable at 11.1 % in 2004 and 11.5% in 2014. On multivariable analysis, factors predictive for receipt of local therapy included more recent year of diagnosis 2010-2014 vs. 2004-2009 (OR 1.21, 95% CI 1.18 e 1.24), age <63 vs 63 (OR 1.43, 95% CI 1.39 e 1.47), treatment at an academic vs non-academic facility (OR 1.97, 95% CI 1.92 e 2.02) and female vs male gender (OR 1.12, 95% CI 1.09 e 1.15). Among those receiving aggressive local therapy, SRT utilization increased from 8.8% in 2004 to 29.0% in 2014. The most common locations of SRT were: 70% Brain, 18.4 % Chest, 5.1% Spine and 6.5% other. On multivariable analysis, factors predictive for receipt of SRT over surgery included more recent year of diagnosis 2010-2014 vs. 2004-2009 (OR 2.19, CI 2.05 e 2.34), treatment at an academic vs non-academic facility (OR 1.30, CI 1.21 e 1.37), highest income quartile vs all other incomes (OR 1.12, CI 1.05 e 1.20), and white vs non-white race (OR 1.11, CI 1.03 e 1.21). Conclusion: We observed increasing utilization of aggressive local therapy among patients with metastatic NSCLC diagnosed in 2004-2014, which appears to have been largely driven by increased use of SRT over time. Author Disclosure: T.J. Hayman: None. T.J. Bledsoe: None. C. Corso: None. N.H. Lester-Coll: Honoraria; Elekta AB. H.S. Park: Employee; Yale-New Haven Hospital. R.H. Decker: Research Grant; Merck and Co, Inc.
Volume 99 Number 2S Supplement 2017 not specified. The median dose delivered was 60Gy in 5 fractions (range 48-75Gy). With a median follow-up of 2 years, the 1-year/3-year LC rates of T1 tumor are 96.5%/90.4%, 90.7%/74.5%, and 89.6%/76.8% in the primary, recurrence, and metastases group respectively. For T2 tumor, 1year/3-year LC rates are 73.3%/48.9%, 80%/53.5%, and 100%/0% respectively. Also, 1-year/3year DFS rates of T1 tumor are 91.8%/91.8%, 90.3%/77.4%, and 84.9%/64.8% in the primary, recurrence and metastases respectively. For T2 tumor, 1-year/3year DFS rates are 74.6%/ 74.6%, 83.3%/55.6%, and 100%/0% respectively. 1-year/3year OS rates of T1 tumor are 93.5%/77.5%, 91.5%/65.6%, and 96.0%/68.4% respectively. For T2 tumor, 1-year/3year OS rates are 69.2%/40.4%, 100%/ 75.0%, and 100%/0% respectively. Five year OS including both T1 and T2 tumors is 58.2%, 58.2%, and 24.4% for primary, recurrence and metastases respectively. Conclusion: One year OS for T1 was excellent and was not significantly different among three groups. Also, DFS of the lung metastases was poorest, but it did not affect OS. Five year OS of primary and recurrence tumors were the same. Therefore, early detection of post-operative recurrence and appropriate use of systemic therapies for lung metastases besides SBRT might have possibility for improving overall survivals longer. Author Disclosure: K. Harada: None.
3090 Pretreatment Factors Influencing Radiation Pneumonitis after Stereotactic Body Radiation Therapy in the Treatment of Lung Cancer A. Harris,1 A. Davis,1 K. Stang,2 F. Alite Jr,2 C. Small,2 R. Hutten,2 B. Emami,2 and M.M. Harkenrider2; 1Grand Rapids Medical Education Partners, Grand Rapids, MI, 2Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL Purpose/Objective(s): Radiation pneumonitis is a dose limiting toxicity that impacts the treatment of patients with lung cancer. Factors predictive of symptomatic radiation pneumonitis have been described for many modalities of radiotherapy, but there is limited data describing these factors for stereotactic body radiation therapy (SBRT). We reviewed patient data to assess for pretreatment factors that are predictive of symptomatic radiation pneumonitis for treatment of lung cancer with SBRT. Materials/Methods: Data was collected on 228 patients who were treated with SBRT for either primary or metastatic lung cancer. Patient and tumor factors were analyzed to assess for a potential correlation to the development of symptomatic radiation pneumonitis, defined as CTCAE v4.0 Grade 2. The specific factors analyzed included patient age, KPS, gender, smoking status, pack year smoking history, tumor location, tumor size, tumor histology, number of sites treated and PFT data including pretreatment percent predicted FVC, FEV1, FVC/FEV1, DlCO. Categorical variables were analyzed using Fischer Exact and Chi Squares tests and continuous variables were analyzed using a univariate logistic regression analysis. Results: The median follow-up was 22 months (1-116 months). The overall rate of symptomatic radiation pneumonitis was 21% (NZ40), with no cases of fatal radiation pneumonitis. In comparison between patients that went on to develop radiation pneumonitis and those that did not, there was no statistically significant difference in the age, gender, KPS, smoking status, or pack years smoked. Similarly, there was no difference in the pretreatment percentage of predicted FVC, FEV1, FEV1/FVC, or DlCO. There was no difference in rate of developing radiation pneumonitis as a function of tumor size, tumor histology, or peripheral vs. central location. There was, however, a statistically significant increased rate of developing radiation pneumonitis with treatments to the right lung over the left lung (26% vs 11%,
pZ0.04) as well as with treating multiple lesions over a single lesion (47% vs 18%, pZ0.03). Conclusion: SBRT to the right lung and the treatment of multiple lesions are risk factors for developing radiation pneumonitis after SBRT in the treatment of lung cancer. Further study on ways to prevent development of radiation pneumonitis is required. Author Disclosure: A. Harris: None. A. Davis: None. K. Stang: None. F. Alite: None. C. Small: None. R. Hutten: None. B. Emami: None. M.M. Harkenrider: None.
3091 Increasing Utilization of Stereotactic Radiation Therapy as a Component of Initial Therapy in Metastatic Nonesmall Cell Lung Cancer T.J. Hayman,1 T.J. Bledsoe,1 C. Corso,1 N.H. Lester-Coll,1 H.S.M. Park,2 and R.H. Decker1; 1Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, 2Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT Purpose/Objective(s): Accumulating evidence suggests that definitive local therapy (e.g. surgery or stereotactic radiotherapy [SRT]) may improve outcomes in well-selected patients with metastatic non-small cell lung cancer (NSCLC). The goal of this study was to determine trends in the utilization of aggressive local therapy over time in patients with metastatic NSCLC as well as factors predicting for the use of SRT versus surgery. Materials/Methods: The National Cancer Data Base was queried to identify patients diagnosed with metastatic NSCLC in 2004 - 2014. SRT was defined as 10 fractions of radiotherapy with a biologically equivalent dose (assuming a/bZ10) of 48-180 Gy calculated using the linearquadratic equation. Kaplan-Meier analysis was used to estimate median survival. The surgery group included patients receiving ablation. Univariable analysis was performed using the chi-square test, and multivariable analysis was performed using a logistic regression model. Results: A total of 270,593 patients with metastatic NSCLC were identified, among whom 38,089 patients (14%) were treated with aggressive local therapy. The median overall survival of this cohort receiving local therapy was 9.1 months. The proportion of patients receiving aggressive local therapy increased from 12.1% in 2004 to 16.2% in 2014. Overall, SRT utilization increased from 1.1 % in 2004 to 4.7% in 2014, whereas surgery utilization remained relatively stable at 11.1 % in 2004 and 11.5% in 2014. On multivariable analysis, factors predictive for receipt of local therapy included more recent year of diagnosis 2010-2014 vs. 2004-2009 (OR 1.21, 95% CI 1.18 e 1.24), age <63 vs 63 (OR 1.43, 95% CI 1.39 e 1.47), treatment at an academic vs non-academic facility (OR 1.97, 95% CI 1.92 e 2.02) and female vs male gender (OR 1.12, 95% CI 1.09 e 1.15). Among those receiving aggressive local therapy, SRT utilization increased from 8.8% in 2004 to 29.0% in 2014. The most common locations of SRT were: 70% Brain, 18.4 % Chest, 5.1% Spine and 6.5% other. On multivariable analysis, factors predictive for receipt of SRT over surgery included more recent year of diagnosis 2010-2014 vs. 2004-2009 (OR 2.19, CI 2.05 e 2.34), treatment at an academic vs non-academic facility (OR 1.30, CI 1.21 e 1.37), highest income quartile vs all other incomes (OR 1.12, CI 1.05 e 1.20), and white vs non-white race (OR 1.11, CI 1.03 e 1.21). Conclusion: We observed increasing utilization of aggressive local therapy among patients with metastatic NSCLC diagnosed in 2004-2014, which appears to have been largely driven by increased use of SRT over time. Author Disclosure: T.J. Hayman: None. T.J. Bledsoe: None. C. Corso: None. N.H. Lester-Coll: Honoraria; Elekta AB. H.S. Park: Employee; Yale-New Haven Hospital. R.H. Decker: Research Grant; Merck and Co, Inc.