- Email: [email protected]
PS02.27 Primary Pulmonary Carcinoid Tumors: A Single Institution Retrospective Review
S1574
Journal of Thoracic Oncology
Background: RRx-001 is a novel anticancer agent with preclinical sensitizing properties to chemotherapy, radiation and immunotherapy as well as chemoprotective effects against platinum toxicities. QUADRUPLE THREAT is a Phase 2 study evaluating the role of RRx-001 in reversing the resistance to platinum-based chemotherapy in patients with previously treated small cell lung cancer (SCLC), high-grade neuroendocrine carcinoma, EGFR mutant non-small cell lung cancer or ovarian cancer. We report the preliminary data on the SCLC cohort. Methods: Patients with recurrent resistant or refractory SCLC, ECOG performance status 0-2 and adequate organ function receive 4 mg RRx001 until Progressive disease (PD) At the time of PD, the original platinum doublet regimen is reintroduced. Primary endpoints include overall survival (OS) and overall response rate (ORR). Results: As of June 19, 2017, 11 patients with histologically confirmed SCLC have been enrolled, of which 8 are currently evaluable. Median follow-up duration is 1.3 months (range 0-13.2 months). No drug-related SAEs have been reported and no patients have discontinued due to drug-related adverse events. To date, confirmed partial responses (PRs) have been observed in 4/8 patients (50%); 1 PR occurred with single-agent RRx-001, the other 3 occurred during platinum doublet therapy after progression on RRx-001. The disease control rate (PR + SD) is 5/8 (63%). OS is still immature but two patients survived longer than one year. Conclusion: Initial results with RRx-001 show promising effects with sensitization to previously used platinum doublet regimens in patients with SCLC, a well-tolerated safety profile and likely chemoprotective effect.
PS02.25 EGFR Mutations and Eye Metastases in Lung Cancer Topic: Medical Oncology M.L. Spiegel,1 J.L. Hunt,2 T. Mccannel,3 B. Ledezma,1 E.B. Garon,4 M. Mendenhall,1 J. Goldman5 1Medicine, Division of Hematology/ Oncology, UCLA, Santa Monica, CA/US, 2Medicine, Division of Hematology, Oncology, UCLA, Santa Monica, CA/US, 3Stein Eye Institute, Los Angeles, CA/US, 4UCLA Medical Center, Los Angeles, CA/US, 5 Medicine, Division of Hematology/Oncology, UCLA, Santa Monica, CA/US Background: Metastases to the eye have been reported in 2-7% of lung cancer patients.1,2 Although lung cancer treatments increasingly focus on the histology and genetics of patient’s tumors, we found only scant literature exploring the tumor genetics of patients with ocular metastases. Methods: We retrospectively reviewed all lung cancer patients seen at the Stein Eye Institute at UCLA, the Jonsson Comprehensive Cancer Center at UCLA, or both starting in calendar year 2014 (when reflex lung cancer mutation testing was initiated). Results: 14 patients with eye metastases were identified: mean age 60 years (range: 49-78 years); 10 female (71%). Histologies included 12 adenocarcinomas, 1 squamous, and 1 bronchial carcinoid. Six (43%) had vision changes as the presenting symptom of their lung cancer. Molecular testing results were available for 11 of the 12 patients with adenocarcinomas. Total (N)
14
Female (N,%) Age (mean, rage) Vision Changes as Presenting Symptom (N, %) Asian Ethnicity (N, %) Histology and Genetics Adenocarcinoma (N) EGFR Mutant KRAS Mutant Ret Rearranged No Mutation Identified No Results Reported Squamous (N) Bronchial Carcinoid (N)
10 60 6 3
(71%) (49-78) (43%) (21%)
12 8 1 1 1 1 1 1
Conclusion: In our single institution experience, we observed that among lung cancer patients with eye metastases there is a significantly higher percentage of EGFR mutations than would be expected among an otherwise unselected population.
Vol. 12 No. 11S1
PS02.26 Multifocal Adenocarcinoma of the Lung: Factors Predictive for Local Therapy Topic: Medical Oncology M.J. Mooradian,1 M. Price,2 A. Muzikansky,3 I. Lennes,1 M. Lanuti,4 H. Willers,5 S. Digumarthy,2 L.V. Sequist1 1Thoracic Oncology, Massachusetts General Hospital, Boston, MA/US, 2Radiology, Massachusetts General Hospital, Boston, MA/US, 3Biostatistics Center, Massachusetts General Hospital, Boston, MA/US, 4Thoracic Surgery, Massachusetts General Hospital, Boston, MA/US, 5Radiation Oncology, Massachusetts General Hospital, Boston, MA/US Background: Multifocal Adenocarinoma (MFA) of the lung is a clinical entity of multiple synchronous or metachronous, often ground-glass opacities (GGO) on CT scan, typically indolent-behaving lung cancers. There is a paucity of clinical data to guide treatment decisions. MFAs are often monitored via serial imaging with local therapy (i.e. radiation, surgery) employed at the discretion of the clinician. We sought to examine factors predictive of local therapy (Tx) at our institution, to develop standardized objective radiolographic parameters to guide treatment. Methods: We retrospectively reviewed pts seen in the MGH Thoracic Oncology Clinic from 2009-15. We excluded pts presumed to have MFA by imaging but without confirmatory pathology, those with calcified nodules and <3 years of imaging. Serial CT scans were reviewed, assessing up to 5 nodules per pt. Demographics and clinical information were collected and univariant and multivariable logistic regression models were fit to assess correlation with Tx. Results: Among the 39 pts identified, 84% were female and 92% were smokers (18% current, 51% former > 10pkyr, 23% former < 10pkyr). 149 nodules were identified with median size 11mm (range 5-55mm); the majority of pts had 3 nodules (36/39). 66 (44%) nodules received Tx (10 RT, 56 surgery). Radiographic variables significantly associated with Tx were baseline nodule size (p¼0.02) and solid density (p<0.001). Nodules > 2.5 cm at baseline had Tx 77% of the time, while those 0.7 cm had Tx 41%. Median length of monitoring before Tx was 2.1 yrs for solid nodules, 3.5 years for sub-solid nodules, and >11 years for pure GGOs. Other observations included discordant genotypes between nodules within 1 point and an overall pattern of nodule contraction just prior to growth acceleration. Conclusion: Lung MFA cases can be successfully managed with serial observation and intervention on growing solid or subsolid nodules. Those with GGO and subsolid components can often be surveyed for years, or if pure GGO, for a decade or more. Larger size at baseline and solid density significantly correlate with the use of Tx. Nodule contraction with concurrent enlargement of the solid component may be an important clinical warning sign. Our findings have the potential to guide clinical practice but will need to be confirmed in larger and ideally prospective cohorts.
PS02.27 Primary Pulmonary Carcinoid Tumors: A Single Institution Retrospective Review Topic: Medical Oncology S. Adediran, E. Friedman, N. Ranjit Medicine, Division of Hematology/ Oncology, Lehigh Valley Hospital Network, Allentown, PA/US Background: Pulmonary carcinoid tumors account for 1e2% of all invasive lung malignancies. They generally occur between the fourth and the sixth decade of life. Most pulmonary carcinoid tumors are well differentiated, have < 2 mitoses/10 HPF and < 3% Ki67 index (typical carcinoid). A small percentage are aggressive, have 2-20 mitoses/10 HPF and 3-20% Ki67 index (atypical carcinoid). We present a
November 2017 retrospective analysis of the clinico-pathologic features of patients diagnosed with pulmonary carcinoids tumor at the LVHN over a ten year period. Methods: Patients with primary pulmonary carcinoid tumors diagnosed between 2005 and 2015 were identified from tumor registry. Records were de-identified and reviewed. Results: Ninety-six patients with primary pulmonary carcinoid were identified. Median age was 63.5 years. 69% were female and 97% were Caucasian. The most common presenting symptoms were cough (22%), dyspnea (17%), chest pain (11%), pneumonia (9%) and hemoptysis (6%). 56% had no symptoms. 86 patients had typical carcinoids and 10 patients had atypical carcinoids. 75% were stage 1, 5% stage II, 4% stage III and 6% stage IV with metastases to bone, lung and liver. 10% had multifocal pulmonary disease. 90% underwent surgery (62% lobectomy, 20% wedge resection, 4% segmental resection, 4% pneumonectomy and 2% endobronchial ablation). Two patients had concurrent lobectomy and wedge resection. Five patients received chemotherapy, 3 with metastatic disease, 1 with stage IIIA and 1 misdiagnosed small cell lung carcinoma. Chemotherapy regimens involved cisplatin and etoposide in 3 patients, and 2 patients received treatment elsewhere. Three patients received radiation therapy. One had prophylactic cranial irradiation, 1 required palliative radiation for painful bony metastases and 1 received concurrent radiation with chemotherapy. Four patients had disease recurrence, 2 of whom died of metastatic pulmonary carcinoid. Ten patients died during the study period from other causes. Conclusion: Primary pulmonary carcinoids are rare tumors more common in females. Common presenting symptoms are cough, dyspnea, chest pain and pneumonia. Surgery is the mainstay of treatment. Chemotherapy and radiation therapy are rarely used except in the metastatic setting. Keeping with the indolent nature of the disease, most patients die of other causes.
PS03.01 Elective Nodal Irradiation for Limited-Stage Small Cell Lung Cancer: A survey of US Radiation Oncologists on Practices Topic: Radiation Oncology M.J. Farrell,1 J. Yahya,1 C. Degnin,1 Y. Chen,1 J.M. Holland,1 M.A. Henderson,1 J.J. Jaboin,1 M.M. Harkenrider,2 C.R. Thomas Jr.,1 T. Mitin1 1Radiation Medicine, Oregon Health and Science University, Portland, OR/US, 2Stritch School of Medicine, Loyola University Chicago, Chicago, IL/US Background: Elective nodal irradiation (ENI) has traditionally been used in clinical trials that have established thoracic radiotherapy (TRT) as instrumental in improving overall survival in patients with limitedstage small cell lung cancer (LS-SCLC). However, several publications suggest that omission of ENI may be appropriate. The current randomized trial CALGB 30610 mandates elective irradiation of ipsilateral hilar lymph nodes only, while EORTC 08072 (CONVERT) omitted ENI completely. Current US practice patterns are unknown in regards to ENI for patients with LS-SCLC. Methods: We surveyed practicing US radiation oncologists (ROs) via an IRB-approved online questionnaire. Questions covered background characteristics, self-rated knowledge of key trials, and treatment recommendations for LS-SCLC, based on several hypothetical clinical scenarios. Results: We received 309 responses from practicing ROs. Only a minority of respondents recommended ENI for patients with LS-SCLC: 21% for N0 disease, 29% for N1 disease, and 30% for N2 disease. 64% did not recommend ENI in any of these clinical scenarios. Respondents who recommended ENI were more likely to have been practicing over 10 years since residency training (p<0.01), more likely to be in private practice rather than an academic setting (p¼0.04), and less likely to be familiar with the ongoing CALGB 30610 trial (p¼0.04). Almost uniformly, respondents prescribe the same RT dose to the primary disease and involved lymph
Poster Sessions
S1575
nodes (93%). When delivering ENI, 36% prescribe the same dose to involved and elective nodes, whereas 64% prescribe a lower dose to elective nodes than involved nodes. Conclusion: In our survey of US ROs, 64% of respondents did not recommend ENI. This is a dramatic shift in practice, as a similar survey of ROs conducted in 2007 showed this number to be 18%. Physicians further away from residency training were more likely to recommend ENI. In the recent EORTC 08072 trial, which omitted ENI, overall survival was higher than previously reported and radiation toxicities were lower than expected in both treatment arms, lending further evidence that omitting ENI should be considered a standard treatment strategy at this time. Results from the CALGB 30610 trial with limited ENI will further elucidate the role of ENI. Education of patients and physicians is essential in aligning practice patterns with the best clinical evidence.
PS03.02 Amifostine as a Cytoprotectant in Small Cell Lung Cancer Topic: Radiation Oncology J. Pollock,1 A.E. Pollock2 1Radiation Oncology, The Schiffler Cancer Center, Wheeling, WV/US, 2Radiation Oncology, Schiffler Cancer Center, Wheeling, WV/US Background: Chemoradiotherapy-induced esophagitis remains a dose limiting toxicity experienced by 35% of patients with locally advanced lung cancer. Data has demonstrated a benefit to intravenous amifostine as a means of reducing acute esophagitis in patients receiving concurrent chemoradiotherpay in non-small cell lung cancer, though none have shown an effect in small cell lung cancer. Our center has adopted a subcutaneous injection schedule and we report our retrospective findings. Methods: 49 patients with stage 3 small cell lung cancer received concurrent thoracic chemoradiotherapy. Chemotherapy consisted of cisplatin (120 mg/m2) and etoposide (60 mg/m2) on days 1 and 21 along with conformal radiotherapy (RT) encompassing CT-identified gross tumor volume. Dose delivery was 150 cGy twice daily with a 6 hour inter-treatment interval (total dose 4500 cGy). In 32 patients (group 1), amifostine was delivered (500 mg, sc divided in two injections) prior to the second daily RT fraction on non-chemotherapy days. The remaining 17 patients (group 2) did not receive amifostine due to choice or intolerance of the drug. Results: Metrics of esophagitis included weight loss and opiate requirement. 31% of group 1 required opiates at a median RT dose of 3300 cGy. 42% of group 2 required opiates during treatment at a median dose of 2250 cGy. Other variables evaluated to determine an association between amifostine use and esophagitis included esophageal V20, V30, and V50. No significant relationship was identified. Figure 1 illustrates a later need for opiate use in the amifostine group but this did not reach significance. Conclusion: In this modern retrospective series of thoracic chemoradiotherapy for stage 3 small cell lung cancer, subcutaneous amifostine did not significantly reduce the incidence of esophagitis. Limitations include small sample size and, due to a trend in postponing the onset of esophagitis, our center continues this practice.
PS03.03 Salvage Therapy for Relapse after Stereotactic Body Radiation for Stage I Lung Cancer Topic: Radiation Oncology Z.A. Oaks, J. Bogart, T. Nsouli, P. Aridgides Radiation Oncology, SUNY Upstate, Syracuse, NY/US Background: To evaluate treatment outcomes of recurrent non-small cell lung cancer (NSCLC) following initial SBRT for stage I disease.
Journal of Thoracic Oncology
Background: RRx-001 is a novel anticancer agent with preclinical sensitizing properties to chemotherapy, radiation and immunotherapy as well as chemoprotective effects against platinum toxicities. QUADRUPLE THREAT is a Phase 2 study evaluating the role of RRx-001 in reversing the resistance to platinum-based chemotherapy in patients with previously treated small cell lung cancer (SCLC), high-grade neuroendocrine carcinoma, EGFR mutant non-small cell lung cancer or ovarian cancer. We report the preliminary data on the SCLC cohort. Methods: Patients with recurrent resistant or refractory SCLC, ECOG performance status 0-2 and adequate organ function receive 4 mg RRx001 until Progressive disease (PD) At the time of PD, the original platinum doublet regimen is reintroduced. Primary endpoints include overall survival (OS) and overall response rate (ORR). Results: As of June 19, 2017, 11 patients with histologically confirmed SCLC have been enrolled, of which 8 are currently evaluable. Median follow-up duration is 1.3 months (range 0-13.2 months). No drug-related SAEs have been reported and no patients have discontinued due to drug-related adverse events. To date, confirmed partial responses (PRs) have been observed in 4/8 patients (50%); 1 PR occurred with single-agent RRx-001, the other 3 occurred during platinum doublet therapy after progression on RRx-001. The disease control rate (PR + SD) is 5/8 (63%). OS is still immature but two patients survived longer than one year. Conclusion: Initial results with RRx-001 show promising effects with sensitization to previously used platinum doublet regimens in patients with SCLC, a well-tolerated safety profile and likely chemoprotective effect.
PS02.25 EGFR Mutations and Eye Metastases in Lung Cancer Topic: Medical Oncology M.L. Spiegel,1 J.L. Hunt,2 T. Mccannel,3 B. Ledezma,1 E.B. Garon,4 M. Mendenhall,1 J. Goldman5 1Medicine, Division of Hematology/ Oncology, UCLA, Santa Monica, CA/US, 2Medicine, Division of Hematology, Oncology, UCLA, Santa Monica, CA/US, 3Stein Eye Institute, Los Angeles, CA/US, 4UCLA Medical Center, Los Angeles, CA/US, 5 Medicine, Division of Hematology/Oncology, UCLA, Santa Monica, CA/US Background: Metastases to the eye have been reported in 2-7% of lung cancer patients.1,2 Although lung cancer treatments increasingly focus on the histology and genetics of patient’s tumors, we found only scant literature exploring the tumor genetics of patients with ocular metastases. Methods: We retrospectively reviewed all lung cancer patients seen at the Stein Eye Institute at UCLA, the Jonsson Comprehensive Cancer Center at UCLA, or both starting in calendar year 2014 (when reflex lung cancer mutation testing was initiated). Results: 14 patients with eye metastases were identified: mean age 60 years (range: 49-78 years); 10 female (71%). Histologies included 12 adenocarcinomas, 1 squamous, and 1 bronchial carcinoid. Six (43%) had vision changes as the presenting symptom of their lung cancer. Molecular testing results were available for 11 of the 12 patients with adenocarcinomas. Total (N)
14
Female (N,%) Age (mean, rage) Vision Changes as Presenting Symptom (N, %) Asian Ethnicity (N, %) Histology and Genetics Adenocarcinoma (N) EGFR Mutant KRAS Mutant Ret Rearranged No Mutation Identified No Results Reported Squamous (N) Bronchial Carcinoid (N)
10 60 6 3
(71%) (49-78) (43%) (21%)
12 8 1 1 1 1 1 1
Conclusion: In our single institution experience, we observed that among lung cancer patients with eye metastases there is a significantly higher percentage of EGFR mutations than would be expected among an otherwise unselected population.
Vol. 12 No. 11S1
PS02.26 Multifocal Adenocarcinoma of the Lung: Factors Predictive for Local Therapy Topic: Medical Oncology M.J. Mooradian,1 M. Price,2 A. Muzikansky,3 I. Lennes,1 M. Lanuti,4 H. Willers,5 S. Digumarthy,2 L.V. Sequist1 1Thoracic Oncology, Massachusetts General Hospital, Boston, MA/US, 2Radiology, Massachusetts General Hospital, Boston, MA/US, 3Biostatistics Center, Massachusetts General Hospital, Boston, MA/US, 4Thoracic Surgery, Massachusetts General Hospital, Boston, MA/US, 5Radiation Oncology, Massachusetts General Hospital, Boston, MA/US Background: Multifocal Adenocarinoma (MFA) of the lung is a clinical entity of multiple synchronous or metachronous, often ground-glass opacities (GGO) on CT scan, typically indolent-behaving lung cancers. There is a paucity of clinical data to guide treatment decisions. MFAs are often monitored via serial imaging with local therapy (i.e. radiation, surgery) employed at the discretion of the clinician. We sought to examine factors predictive of local therapy (Tx) at our institution, to develop standardized objective radiolographic parameters to guide treatment. Methods: We retrospectively reviewed pts seen in the MGH Thoracic Oncology Clinic from 2009-15. We excluded pts presumed to have MFA by imaging but without confirmatory pathology, those with calcified nodules and <3 years of imaging. Serial CT scans were reviewed, assessing up to 5 nodules per pt. Demographics and clinical information were collected and univariant and multivariable logistic regression models were fit to assess correlation with Tx. Results: Among the 39 pts identified, 84% were female and 92% were smokers (18% current, 51% former > 10pkyr, 23% former < 10pkyr). 149 nodules were identified with median size 11mm (range 5-55mm); the majority of pts had 3 nodules (36/39). 66 (44%) nodules received Tx (10 RT, 56 surgery). Radiographic variables significantly associated with Tx were baseline nodule size (p¼0.02) and solid density (p<0.001). Nodules > 2.5 cm at baseline had Tx 77% of the time, while those 0.7 cm had Tx 41%. Median length of monitoring before Tx was 2.1 yrs for solid nodules, 3.5 years for sub-solid nodules, and >11 years for pure GGOs. Other observations included discordant genotypes between nodules within 1 point and an overall pattern of nodule contraction just prior to growth acceleration. Conclusion: Lung MFA cases can be successfully managed with serial observation and intervention on growing solid or subsolid nodules. Those with GGO and subsolid components can often be surveyed for years, or if pure GGO, for a decade or more. Larger size at baseline and solid density significantly correlate with the use of Tx. Nodule contraction with concurrent enlargement of the solid component may be an important clinical warning sign. Our findings have the potential to guide clinical practice but will need to be confirmed in larger and ideally prospective cohorts.
PS02.27 Primary Pulmonary Carcinoid Tumors: A Single Institution Retrospective Review Topic: Medical Oncology S. Adediran, E. Friedman, N. Ranjit Medicine, Division of Hematology/ Oncology, Lehigh Valley Hospital Network, Allentown, PA/US Background: Pulmonary carcinoid tumors account for 1e2% of all invasive lung malignancies. They generally occur between the fourth and the sixth decade of life. Most pulmonary carcinoid tumors are well differentiated, have < 2 mitoses/10 HPF and < 3% Ki67 index (typical carcinoid). A small percentage are aggressive, have 2-20 mitoses/10 HPF and 3-20% Ki67 index (atypical carcinoid). We present a
November 2017 retrospective analysis of the clinico-pathologic features of patients diagnosed with pulmonary carcinoids tumor at the LVHN over a ten year period. Methods: Patients with primary pulmonary carcinoid tumors diagnosed between 2005 and 2015 were identified from tumor registry. Records were de-identified and reviewed. Results: Ninety-six patients with primary pulmonary carcinoid were identified. Median age was 63.5 years. 69% were female and 97% were Caucasian. The most common presenting symptoms were cough (22%), dyspnea (17%), chest pain (11%), pneumonia (9%) and hemoptysis (6%). 56% had no symptoms. 86 patients had typical carcinoids and 10 patients had atypical carcinoids. 75% were stage 1, 5% stage II, 4% stage III and 6% stage IV with metastases to bone, lung and liver. 10% had multifocal pulmonary disease. 90% underwent surgery (62% lobectomy, 20% wedge resection, 4% segmental resection, 4% pneumonectomy and 2% endobronchial ablation). Two patients had concurrent lobectomy and wedge resection. Five patients received chemotherapy, 3 with metastatic disease, 1 with stage IIIA and 1 misdiagnosed small cell lung carcinoma. Chemotherapy regimens involved cisplatin and etoposide in 3 patients, and 2 patients received treatment elsewhere. Three patients received radiation therapy. One had prophylactic cranial irradiation, 1 required palliative radiation for painful bony metastases and 1 received concurrent radiation with chemotherapy. Four patients had disease recurrence, 2 of whom died of metastatic pulmonary carcinoid. Ten patients died during the study period from other causes. Conclusion: Primary pulmonary carcinoids are rare tumors more common in females. Common presenting symptoms are cough, dyspnea, chest pain and pneumonia. Surgery is the mainstay of treatment. Chemotherapy and radiation therapy are rarely used except in the metastatic setting. Keeping with the indolent nature of the disease, most patients die of other causes.
PS03.01 Elective Nodal Irradiation for Limited-Stage Small Cell Lung Cancer: A survey of US Radiation Oncologists on Practices Topic: Radiation Oncology M.J. Farrell,1 J. Yahya,1 C. Degnin,1 Y. Chen,1 J.M. Holland,1 M.A. Henderson,1 J.J. Jaboin,1 M.M. Harkenrider,2 C.R. Thomas Jr.,1 T. Mitin1 1Radiation Medicine, Oregon Health and Science University, Portland, OR/US, 2Stritch School of Medicine, Loyola University Chicago, Chicago, IL/US Background: Elective nodal irradiation (ENI) has traditionally been used in clinical trials that have established thoracic radiotherapy (TRT) as instrumental in improving overall survival in patients with limitedstage small cell lung cancer (LS-SCLC). However, several publications suggest that omission of ENI may be appropriate. The current randomized trial CALGB 30610 mandates elective irradiation of ipsilateral hilar lymph nodes only, while EORTC 08072 (CONVERT) omitted ENI completely. Current US practice patterns are unknown in regards to ENI for patients with LS-SCLC. Methods: We surveyed practicing US radiation oncologists (ROs) via an IRB-approved online questionnaire. Questions covered background characteristics, self-rated knowledge of key trials, and treatment recommendations for LS-SCLC, based on several hypothetical clinical scenarios. Results: We received 309 responses from practicing ROs. Only a minority of respondents recommended ENI for patients with LS-SCLC: 21% for N0 disease, 29% for N1 disease, and 30% for N2 disease. 64% did not recommend ENI in any of these clinical scenarios. Respondents who recommended ENI were more likely to have been practicing over 10 years since residency training (p<0.01), more likely to be in private practice rather than an academic setting (p¼0.04), and less likely to be familiar with the ongoing CALGB 30610 trial (p¼0.04). Almost uniformly, respondents prescribe the same RT dose to the primary disease and involved lymph
Poster Sessions
S1575
nodes (93%). When delivering ENI, 36% prescribe the same dose to involved and elective nodes, whereas 64% prescribe a lower dose to elective nodes than involved nodes. Conclusion: In our survey of US ROs, 64% of respondents did not recommend ENI. This is a dramatic shift in practice, as a similar survey of ROs conducted in 2007 showed this number to be 18%. Physicians further away from residency training were more likely to recommend ENI. In the recent EORTC 08072 trial, which omitted ENI, overall survival was higher than previously reported and radiation toxicities were lower than expected in both treatment arms, lending further evidence that omitting ENI should be considered a standard treatment strategy at this time. Results from the CALGB 30610 trial with limited ENI will further elucidate the role of ENI. Education of patients and physicians is essential in aligning practice patterns with the best clinical evidence.
PS03.02 Amifostine as a Cytoprotectant in Small Cell Lung Cancer Topic: Radiation Oncology J. Pollock,1 A.E. Pollock2 1Radiation Oncology, The Schiffler Cancer Center, Wheeling, WV/US, 2Radiation Oncology, Schiffler Cancer Center, Wheeling, WV/US Background: Chemoradiotherapy-induced esophagitis remains a dose limiting toxicity experienced by 35% of patients with locally advanced lung cancer. Data has demonstrated a benefit to intravenous amifostine as a means of reducing acute esophagitis in patients receiving concurrent chemoradiotherpay in non-small cell lung cancer, though none have shown an effect in small cell lung cancer. Our center has adopted a subcutaneous injection schedule and we report our retrospective findings. Methods: 49 patients with stage 3 small cell lung cancer received concurrent thoracic chemoradiotherapy. Chemotherapy consisted of cisplatin (120 mg/m2) and etoposide (60 mg/m2) on days 1 and 21 along with conformal radiotherapy (RT) encompassing CT-identified gross tumor volume. Dose delivery was 150 cGy twice daily with a 6 hour inter-treatment interval (total dose 4500 cGy). In 32 patients (group 1), amifostine was delivered (500 mg, sc divided in two injections) prior to the second daily RT fraction on non-chemotherapy days. The remaining 17 patients (group 2) did not receive amifostine due to choice or intolerance of the drug. Results: Metrics of esophagitis included weight loss and opiate requirement. 31% of group 1 required opiates at a median RT dose of 3300 cGy. 42% of group 2 required opiates during treatment at a median dose of 2250 cGy. Other variables evaluated to determine an association between amifostine use and esophagitis included esophageal V20, V30, and V50. No significant relationship was identified. Figure 1 illustrates a later need for opiate use in the amifostine group but this did not reach significance. Conclusion: In this modern retrospective series of thoracic chemoradiotherapy for stage 3 small cell lung cancer, subcutaneous amifostine did not significantly reduce the incidence of esophagitis. Limitations include small sample size and, due to a trend in postponing the onset of esophagitis, our center continues this practice.
PS03.03 Salvage Therapy for Relapse after Stereotactic Body Radiation for Stage I Lung Cancer Topic: Radiation Oncology Z.A. Oaks, J. Bogart, T. Nsouli, P. Aridgides Radiation Oncology, SUNY Upstate, Syracuse, NY/US Background: To evaluate treatment outcomes of recurrent non-small cell lung cancer (NSCLC) following initial SBRT for stage I disease.