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PUB003 Metastases in T1-T2 classed Lung Cancer
ABSTRACTS PUBLISH ONLY PUB001 Epid-Based in Vivo Dosimetry for Accurate Delivery of Lung Stereotactic Radiotherapy Using Breath-Hold Segmented VMAT S. Cilla,1 A. Ianiro,1 M. Craus,1 P. Viola,1 F. Deodato,2 G. Macchia,2 L. Azario,3 A. Fidanzio,3 M. De Spirito,3 A. Morganti,4 V. Valentini,3 A. Piermattei3 1Medical Physics Unit, Foundation of Research and Cure John Paul Ii, Campobasso/IT, 2Radiation Oncology Unit, Foundation of Research and Cure John Paul Ii, Campobasso/IT, 3Mexical Physics Unit, Catholic University of Sacred Heart, Roma/IT, 4Radiation Oncoligy Unit, University of Bologna, Bologna/IT Background: In vivo dosimetry (IVD), a direct method of measuring radiation doses to cancer patients during treatment, has shown unique features to trace deviations between planned and actually delivered dose distributions. Lung stereotactic ablative radiotherapy (SBRT) involves the delivery of high doses in a few fractions for ablative purposes. Then SBRT treatments strongly benefit from IVD procedures, as any uncertainties in dose delivery is more detrimental for treatment goals. We assessed the feasibility of EPID-based IVD for clinical lung SBRT treatments using VMAT technique. Method: 8 patients with lung metastases treated with Elekta VMAT were enrolled. Dose prescription was 50Gy in 5 fractions. Patients were simulated and treated using the Active Breath Coordinator (Elekta), a spirometer enabling a temporary controlled interruption of patient breathing at the end of inspiration phase. VMAT plans were generated with Ergo++ TPS with a single 360 arc; the VMAT delivery sequence was divided into multiple subarcs according to the patient predefined breath-hold periods. IVD was performed using SOFTDISO software (Best Medical Italy). IVD tests were evaluate by means of (i) R ratio between isocenter daily in-vivo dose and planned dose and (ii) g-analysis between EPID integral images in terms of percentage of points with g-value smaller than one (g%) and mean g-values (gmean), using a global 3%-3 mm criteria. Alert criteria of ±5% for R ratio, g% <90% and gmean > 0.67 were chosen., the last two in order to accept only 10% of the values to exceed 3%/3mm and an average discrepancy of the order of 2%/2mm, respectively. Result: A total of 40 transit EPID images were acquired. Two images (5%) were removed from analysis for image deterioration and/or electronic acquisition failures. The overall mean R ratio was equal to 0.999 ± 0.021 (1 SD) for all patients, with more than 98% of tests within 5% alert criteria. The 2D portal images g-analysis show an overall gmean of 0.29±0.13 with 100% of tests within alert criteria, and a mean g% equal to 97.9±3.2% with 100.0% of tests within alert criteria. The results are supplied in quasi real-time, with IVD tests performed and displayed after only 1 minute from the end of arc delivery. Conclusion: Our results showed that the integration of ABC multi-segmented breath-hold control into the VMAT-SBRT delivery strategy translated in high reproducibility treatments. Keywords: SBRT, In-vivo dosimetry, Breath-hold
PUB002 Nivolumab in Second-Line Treatment for Advanced Non-Small Cell Lung Cancer with Squamous Cell Histology: A Cost-Effective Choice J. Giuliani, A. Bonetti Oncology, Mater Salutis Hospital - Az. Ulss 9 Scaligera, Legnago (Vr)/IT Background: The introduction of active new agents, such as nivolumab, for the second-line treatment of advanced non-small cell lung
cancer (NSCLC) with squamous cell histology is associated with a relevant increase of costs and it is therefore important to make a balance between the costs of treatment and the added value represented by the improvement of the clinical parameters of interest such as progression free survival (PFS) and overall survival (OS). Method: The analysis was conducted to assess the effect of front-line chemotherapy on the PFS and OS on each arm of the evaluated trials. Only phase III randomized controlled trials (RCTs) were considered. We calculated the pharmacological costs necessary to get the benefit in PFS and OS, for each trial. We have also applied the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) to the above pivotal phase III RCTs Result: We evaluated the 2 pivotal phase III RCTs, including 815 patients. The application of ESMO-MCBS reached high scores for the two pivotal phase III RCTs (grade 5 for Brahmer et al Trial and grade 4 for Broghaei et al Trial). Concerning both PFS and OS, the most relevant increase of costs was associated with the use of nivolumab, with the highest costs for month of PFSgained (31 294 V), but with the lowest cost for month of OS-gain (from 5856 V to 6846 V). Conclusion: Combining pharmacological costs of drugs with the measure of efficacy represented by the OS, nivolumab is a cost-effective second-line treatment for patients with advanced NSCLC with squamous cell histology. The lack of correlation between PFS and OS is a well-known phenomenon with the clinical use of check point inhibitors and reinforces the importance of the evaluation of OS as a strong end-point, even on a pharmaco-economic perspective. Keywords: squamous cell histology, Advanced Non-Small Cell Lung Cancer, Nivolumab
PUB003 Metastases in T1-T2 classed Lung Cancer H. Neji,1 R. Ouji,2 M. Attia,1 H. Gharsalli,2 S. Laabidi,3 I. Baccouche,2 A. Mekkaoui,4 S. Hantous-Zannad,2 K. Ben Miled-M’Rad2 1Radiology Department, Abderrahmen Mami Hospital, Ariana/TN, 2Abderrahmen Mami Hospital, Ariana/TN, 3 Oncology, Abderrahmen Mami Hospital, Ariana/TN, 4Imaging Department, Abderrahmen Mami Hospital, Ariana/TN Background: Lung cancer is the first cancer responsible for metastases. They can be either intra-or extra-thoracic. Their diagnosis when the cancer is locally non-advanced modifies completely the treatment. The aim of this work is to find out variables influencing metastases occurrence in T1-T2 classed lung cancer. Method: Retrospective review of data of 63 patients (60 males and 3 females) with confirmed lung cancer, which were classed T1 or T2 according to the TNM 7 in the work up of their disease and who were explored in the imaging department of our institution between January 2011 and December 2016. Patients were subdivided into two groups: with or without metastases. The variables tested to find out a relationship with metastases occurrence were age, T1 or T2 status, N status and histological type of the cancer. A significant statistical relationship was retained when p was 0.05. Result: The mean age of the included patients was 61 years (ranging between 43 and 73 years). Adenocarcinoma was the most common histological type (71%). Twenty seven patients (43%) had metastases; 21 of them (77%) had extra-thoracic ones. Comparing patients with and without metastases, no significant relationship was found between the T1 or T2 stage (p¼ 0.147), the age (p¼0.745) and metastases occurrence. In the opposite, they were statistically related to N2-N3 lymph nodes stage (p¼0.032) and to adenocarcinoma (p¼0.006). Conclusion: Metastases are quite frequent in T1-T2 classed lung cancer. Their occurrence was related to the N stage and to the adenocarcinoma. Keywords: lung cancer, Metastases, T1- T2
Journal of Thoracic Oncology
Vol. 12 No. 11S2: S2365-S2394
PUB002 Nivolumab in Second-Line Treatment for Advanced Non-Small Cell Lung Cancer with Squamous Cell Histology: A Cost-Effective Choice J. Giuliani, A. Bonetti Oncology, Mater Salutis Hospital - Az. Ulss 9 Scaligera, Legnago (Vr)/IT Background: The introduction of active new agents, such as nivolumab, for the second-line treatment of advanced non-small cell lung
cancer (NSCLC) with squamous cell histology is associated with a relevant increase of costs and it is therefore important to make a balance between the costs of treatment and the added value represented by the improvement of the clinical parameters of interest such as progression free survival (PFS) and overall survival (OS). Method: The analysis was conducted to assess the effect of front-line chemotherapy on the PFS and OS on each arm of the evaluated trials. Only phase III randomized controlled trials (RCTs) were considered. We calculated the pharmacological costs necessary to get the benefit in PFS and OS, for each trial. We have also applied the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) to the above pivotal phase III RCTs Result: We evaluated the 2 pivotal phase III RCTs, including 815 patients. The application of ESMO-MCBS reached high scores for the two pivotal phase III RCTs (grade 5 for Brahmer et al Trial and grade 4 for Broghaei et al Trial). Concerning both PFS and OS, the most relevant increase of costs was associated with the use of nivolumab, with the highest costs for month of PFSgained (31 294 V), but with the lowest cost for month of OS-gain (from 5856 V to 6846 V). Conclusion: Combining pharmacological costs of drugs with the measure of efficacy represented by the OS, nivolumab is a cost-effective second-line treatment for patients with advanced NSCLC with squamous cell histology. The lack of correlation between PFS and OS is a well-known phenomenon with the clinical use of check point inhibitors and reinforces the importance of the evaluation of OS as a strong end-point, even on a pharmaco-economic perspective. Keywords: squamous cell histology, Advanced Non-Small Cell Lung Cancer, Nivolumab
PUB003 Metastases in T1-T2 classed Lung Cancer H. Neji,1 R. Ouji,2 M. Attia,1 H. Gharsalli,2 S. Laabidi,3 I. Baccouche,2 A. Mekkaoui,4 S. Hantous-Zannad,2 K. Ben Miled-M’Rad2 1Radiology Department, Abderrahmen Mami Hospital, Ariana/TN, 2Abderrahmen Mami Hospital, Ariana/TN, 3 Oncology, Abderrahmen Mami Hospital, Ariana/TN, 4Imaging Department, Abderrahmen Mami Hospital, Ariana/TN Background: Lung cancer is the first cancer responsible for metastases. They can be either intra-or extra-thoracic. Their diagnosis when the cancer is locally non-advanced modifies completely the treatment. The aim of this work is to find out variables influencing metastases occurrence in T1-T2 classed lung cancer. Method: Retrospective review of data of 63 patients (60 males and 3 females) with confirmed lung cancer, which were classed T1 or T2 according to the TNM 7 in the work up of their disease and who were explored in the imaging department of our institution between January 2011 and December 2016. Patients were subdivided into two groups: with or without metastases. The variables tested to find out a relationship with metastases occurrence were age, T1 or T2 status, N status and histological type of the cancer. A significant statistical relationship was retained when p was 0.05. Result: The mean age of the included patients was 61 years (ranging between 43 and 73 years). Adenocarcinoma was the most common histological type (71%). Twenty seven patients (43%) had metastases; 21 of them (77%) had extra-thoracic ones. Comparing patients with and without metastases, no significant relationship was found between the T1 or T2 stage (p¼ 0.147), the age (p¼0.745) and metastases occurrence. In the opposite, they were statistically related to N2-N3 lymph nodes stage (p¼0.032) and to adenocarcinoma (p¼0.006). Conclusion: Metastases are quite frequent in T1-T2 classed lung cancer. Their occurrence was related to the N stage and to the adenocarcinoma. Keywords: lung cancer, Metastases, T1- T2
Journal of Thoracic Oncology
Vol. 12 No. 11S2: S2365-S2394