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IV Non–Small Cell Lung Cancer
E472
International Journal of Radiation Oncology Biology Physics
38% (grade 3) and the median rate of treatment-related death was 21% (range 5-22%). Median one-year local control was 70% (range 63-100%) and median one-year overall survival was 68% (range 54-100%) in this cohort of patients. Conclusion: The use of SABR for ultra-central lung tumors is feasible, with good local control, but the risk of treatment-related death is high. In the era of shared decision making, patients should be cautioned about the risks and benefits of SABR in this context. Further research is needed to define the optimal dose and fractionation of radiation for ultra-central tumors. Author Disclosure: J.M. Laba: None. H. Chen: None. G. Boldt: None. D.A. Palma: Research Grant; Ontario Institute for Cancer Research. Patent/License Fees/Copyright; U.S. Patent Pending. A.V. Louie: Honoraria; Varian Medical Systems Inc.
Materials/Methods: Data from all consecutive patients with oligometastatic NSCLC to the adrenal gland were prospectively evaluated. Twentysix adrenal metastases from NSCLC (19 adenocarcinoma, 4 squamous cell carcinoma, 2 bronchogenic carcinoma and 1 large cell carcinoma) were treated in 23 individuals. Age at treatment ranged from 42 e 77 years (mean 62) with 13 men and 10 women. Two patients had bilateral adrenal metastases. Tumor volumes ranged from 2.7 e 168 cc (mean 44.2 cc) and were treated with 500 e 900cGy per fraction, in 5 e 8 fractions, to a cumulative dose of 2,500 e 4,500cGy (mode 4,000cGy). Cancers were followed with MRI, CT and PET scans. Tumor control was defined as cessation of growth, shrinkage, or disappearance of the treated cancer. Results: At analysis, follow-up ranged from 1 e 53 months (mean 10 months). There was an overall 88% control rate for NSCLC. Univariate logistic regression of tumor response showed that histology, age, total dose, pre-treatment volume, and gender were not significant predictors of local control. One patient with progression of both their adrenal metastases initially had tumor regression, but progressed as their primary disease subsequently grew. Another patient with tumor growth following SBRT underwent re-irradiation which continued to provide tumor control at last follow-up (30 months). The treatments were generally well tolerated without significant adverse events. Conclusion: In our experience, SBRT for oligometastatic NSCLC in the adrenal gland provides a safe, non-invasive treatment modality with a high rate of local tumor control. Patients with oligometastatic lung cancer treated to adrenal gland metastases continue to be evaluated for longer follow-up in order to determine if controlling the extrathoracic disease translates to a progression free and overall survival benefit. Author Disclosure: A.J. Lederman: None. D.J. Arbit: None. A. Lee: None. V.W. Osborn: None. M. Loksen: None. D. Izon: None. T. Lowinger: None. G.S. Lederman: None.
3118 Radical Hypo-Fractionated Radiotherapy in Patient with Medically Inoperable or Refusal of Surgery Stage III/IV NoneSmall Cell Lung Cancer J. Lang, S. Lu, M. Feng, and W. Wang; Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China Purpose/Objective(s): Local control failure is an important factor of unsatisfactory efficacy of conventional radiotherapy for non-small cell lung cancer. Hypo-fractionated radiotherapy can minimize the negative effect of rapid tumor repopulation due to the overtime prolonged. We retrospectively analyzed the treatment outcomes and toxicities by hypofractionated radiotherapy in the patients with primary nonesmall-cell lung cancer (NSCLC). Materials/Methods: 86 patients with primary NSCLC received radical RT to the tumor at lung over 2.5 Gy per fraction for either medical comorbidity or refusal of surgery, between January 2006 and December 2013. The median total dose was 40e78Gy.Toxicities were graded according to CTCAE V4.0. Survival rates were estimated using the Kaplan-Meier method. Results: The median follow-up was 25 months (range 3-84 months).Stage III 27.9%(24/86人), stage IV 72.1%(62/86人),both median total dose was 60Gy.BED of all patient was over 60Gy.The local control (LC) and overall survival (OS) at 1,2 and 3 years for stage III patient were 62.5%,20.8% and 12.5%; and 87.5%, 41.7%, and 12.5% respectively. The local control (LC) and overall survival (OS) at 1,2 and 3 years for stage IV patient were 67.7%,22.5% and 11.3%; and 77.4%, 35.5%, and 14.5% respectively. The LC and OS at 1, 2, 3-year were no significant difference between the two groups. There was no significant difference of grade 3 late adverse effects between the two groups. There was only 3/24 and 7/62 patient with 3+ radiation side effects. Conclusion: Radical hypofractionated RT regimen for medically inoperable or refusal of surgery stage III/IV NSCLC proved safe with minimal toxicity. Key Words: Nonesmall-cell lung cancer, hypo-fractionated radiotherapy Author Disclosure: J. Lang: None. S. Lu: None. M. Feng: None. W. Wang: None.
3119 Response of Oligometastatic NoneSmall Cell Lung Cancer to the Adrenal Gland Treated with Stereotactic Body Radiosurgery A.J. Lederman, D.J. Arbit, A. Lee, V.W. Osborn, M. Loksen, D. Izon, T. Lowinger, and G.S. Lederman; Radiosurgery New York, New York, NY Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) delivers high-dose hypofractionated radiation precisely to a particular site of cancer. The results of SBRT on local control for patients with oligometastatic Non-Small Cell Lung Cancer (NSCLC) with adrenal metastases were analyzed in this prospective study.
3120 Characterizing Heterogeneous Responses to Systemic Therapy in Nonesmall Cell Lung Cancer Using FDG-PET A. Lee, T. Abraham, and N. Ohri; Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY Purpose/Objective(s): Established guidelines used to determine response evaluation of FDT-PET are based on maximum or peak activity. Many patients, especially those with widespread disease, may have “mixed” or heterogeneous responses to systemic therapy. We previously developed a rapid algorithm for visualizing and quantifying PET response heterogeneity in Stage III non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy. Here we extend that methodology to a cohort of patients with metastatic NSCLC treated with either tyrosine-kinase inhibitors (TKI), immunotherapy (IT), or cytotoxic chemotherapy (CC). Materials/Methods: We identified patients who were treated with TKIs, IT, or CC for metastatic NSCLC at our institution between 2012 and 2017 and who underwent pre- and post-treatment PET. For each patient, pre- and post-treatment PET scans were coregistered using a commercially-available software package (MIMvista Corp, Cleveland, OH). All visible hypermetabolic lesions were delineated on each scan using a semiautomatic gradient-based contouring tool. A maximum of 35 lesions were contoured for each patient. Maximum standardized uptake value (SUV), metabolic tumor volume (MTV), and total glycolytic activity (TGA) for each lesion and scan were tabulated. For each patient, an intrapatient waterfall plot was generated to depict the range of responses observed for each metric across all lesions. A response heterogeneity index (RHI) was defined for each patient with more than one hypermetabolic lesion as the standard deviation of the percent changes in TGA observed across all lesions. We tabulated the frequency of heterogeneous responses, defined based on our previous work as having an RHI exceeding 20%. Results: Nineteen patients met all inclusion criteria. 178 hypermetabolic lesions were contoured in total (range: 1 to 35 per patient). One patient had a complete response, and two had a single hypermetabolic lesion. Among the remaining patients, 15/16 (94%) demonstrated a heterogeneous
International Journal of Radiation Oncology Biology Physics
38% (grade 3) and the median rate of treatment-related death was 21% (range 5-22%). Median one-year local control was 70% (range 63-100%) and median one-year overall survival was 68% (range 54-100%) in this cohort of patients. Conclusion: The use of SABR for ultra-central lung tumors is feasible, with good local control, but the risk of treatment-related death is high. In the era of shared decision making, patients should be cautioned about the risks and benefits of SABR in this context. Further research is needed to define the optimal dose and fractionation of radiation for ultra-central tumors. Author Disclosure: J.M. Laba: None. H. Chen: None. G. Boldt: None. D.A. Palma: Research Grant; Ontario Institute for Cancer Research. Patent/License Fees/Copyright; U.S. Patent Pending. A.V. Louie: Honoraria; Varian Medical Systems Inc.
Materials/Methods: Data from all consecutive patients with oligometastatic NSCLC to the adrenal gland were prospectively evaluated. Twentysix adrenal metastases from NSCLC (19 adenocarcinoma, 4 squamous cell carcinoma, 2 bronchogenic carcinoma and 1 large cell carcinoma) were treated in 23 individuals. Age at treatment ranged from 42 e 77 years (mean 62) with 13 men and 10 women. Two patients had bilateral adrenal metastases. Tumor volumes ranged from 2.7 e 168 cc (mean 44.2 cc) and were treated with 500 e 900cGy per fraction, in 5 e 8 fractions, to a cumulative dose of 2,500 e 4,500cGy (mode 4,000cGy). Cancers were followed with MRI, CT and PET scans. Tumor control was defined as cessation of growth, shrinkage, or disappearance of the treated cancer. Results: At analysis, follow-up ranged from 1 e 53 months (mean 10 months). There was an overall 88% control rate for NSCLC. Univariate logistic regression of tumor response showed that histology, age, total dose, pre-treatment volume, and gender were not significant predictors of local control. One patient with progression of both their adrenal metastases initially had tumor regression, but progressed as their primary disease subsequently grew. Another patient with tumor growth following SBRT underwent re-irradiation which continued to provide tumor control at last follow-up (30 months). The treatments were generally well tolerated without significant adverse events. Conclusion: In our experience, SBRT for oligometastatic NSCLC in the adrenal gland provides a safe, non-invasive treatment modality with a high rate of local tumor control. Patients with oligometastatic lung cancer treated to adrenal gland metastases continue to be evaluated for longer follow-up in order to determine if controlling the extrathoracic disease translates to a progression free and overall survival benefit. Author Disclosure: A.J. Lederman: None. D.J. Arbit: None. A. Lee: None. V.W. Osborn: None. M. Loksen: None. D. Izon: None. T. Lowinger: None. G.S. Lederman: None.
3118 Radical Hypo-Fractionated Radiotherapy in Patient with Medically Inoperable or Refusal of Surgery Stage III/IV NoneSmall Cell Lung Cancer J. Lang, S. Lu, M. Feng, and W. Wang; Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China Purpose/Objective(s): Local control failure is an important factor of unsatisfactory efficacy of conventional radiotherapy for non-small cell lung cancer. Hypo-fractionated radiotherapy can minimize the negative effect of rapid tumor repopulation due to the overtime prolonged. We retrospectively analyzed the treatment outcomes and toxicities by hypofractionated radiotherapy in the patients with primary nonesmall-cell lung cancer (NSCLC). Materials/Methods: 86 patients with primary NSCLC received radical RT to the tumor at lung over 2.5 Gy per fraction for either medical comorbidity or refusal of surgery, between January 2006 and December 2013. The median total dose was 40e78Gy.Toxicities were graded according to CTCAE V4.0. Survival rates were estimated using the Kaplan-Meier method. Results: The median follow-up was 25 months (range 3-84 months).Stage III 27.9%(24/86人), stage IV 72.1%(62/86人),both median total dose was 60Gy.BED of all patient was over 60Gy.The local control (LC) and overall survival (OS) at 1,2 and 3 years for stage III patient were 62.5%,20.8% and 12.5%; and 87.5%, 41.7%, and 12.5% respectively. The local control (LC) and overall survival (OS) at 1,2 and 3 years for stage IV patient were 67.7%,22.5% and 11.3%; and 77.4%, 35.5%, and 14.5% respectively. The LC and OS at 1, 2, 3-year were no significant difference between the two groups. There was no significant difference of grade 3 late adverse effects between the two groups. There was only 3/24 and 7/62 patient with 3+ radiation side effects. Conclusion: Radical hypofractionated RT regimen for medically inoperable or refusal of surgery stage III/IV NSCLC proved safe with minimal toxicity. Key Words: Nonesmall-cell lung cancer, hypo-fractionated radiotherapy Author Disclosure: J. Lang: None. S. Lu: None. M. Feng: None. W. Wang: None.
3119 Response of Oligometastatic NoneSmall Cell Lung Cancer to the Adrenal Gland Treated with Stereotactic Body Radiosurgery A.J. Lederman, D.J. Arbit, A. Lee, V.W. Osborn, M. Loksen, D. Izon, T. Lowinger, and G.S. Lederman; Radiosurgery New York, New York, NY Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) delivers high-dose hypofractionated radiation precisely to a particular site of cancer. The results of SBRT on local control for patients with oligometastatic Non-Small Cell Lung Cancer (NSCLC) with adrenal metastases were analyzed in this prospective study.
3120 Characterizing Heterogeneous Responses to Systemic Therapy in Nonesmall Cell Lung Cancer Using FDG-PET A. Lee, T. Abraham, and N. Ohri; Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY Purpose/Objective(s): Established guidelines used to determine response evaluation of FDT-PET are based on maximum or peak activity. Many patients, especially those with widespread disease, may have “mixed” or heterogeneous responses to systemic therapy. We previously developed a rapid algorithm for visualizing and quantifying PET response heterogeneity in Stage III non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy. Here we extend that methodology to a cohort of patients with metastatic NSCLC treated with either tyrosine-kinase inhibitors (TKI), immunotherapy (IT), or cytotoxic chemotherapy (CC). Materials/Methods: We identified patients who were treated with TKIs, IT, or CC for metastatic NSCLC at our institution between 2012 and 2017 and who underwent pre- and post-treatment PET. For each patient, pre- and post-treatment PET scans were coregistered using a commercially-available software package (MIMvista Corp, Cleveland, OH). All visible hypermetabolic lesions were delineated on each scan using a semiautomatic gradient-based contouring tool. A maximum of 35 lesions were contoured for each patient. Maximum standardized uptake value (SUV), metabolic tumor volume (MTV), and total glycolytic activity (TGA) for each lesion and scan were tabulated. For each patient, an intrapatient waterfall plot was generated to depict the range of responses observed for each metric across all lesions. A response heterogeneity index (RHI) was defined for each patient with more than one hypermetabolic lesion as the standard deviation of the percent changes in TGA observed across all lesions. We tabulated the frequency of heterogeneous responses, defined based on our previous work as having an RHI exceeding 20%. Results: Nineteen patients met all inclusion criteria. 178 hypermetabolic lesions were contoured in total (range: 1 to 35 per patient). One patient had a complete response, and two had a single hypermetabolic lesion. Among the remaining patients, 15/16 (94%) demonstrated a heterogeneous