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Safety and Efficacy of Stereotactic Body Radiation Therapy (SBRT) Reirradiation for New or Recurrent Pulmonary Malignancies Following Previous In-Field Conventionally Fractionated Thoracic Radiation Therapy (CFRT)
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Volume 90 Number 1S Supplement 2014
3051 45 Gy Versus 54 Gy of Accelerated Hyperfractionated Radiation Therapy for Patients With Limited-Stage Small Cell Lung Cancer: A Retrospective Analysis of a 7-Year Experience Y. Takeuchi,1 K. Matsuura,1 T. Katsuta,1 T. Okabe,2 and M. Kagemoto1; 1 Hiroshima City Hospital, Hiroshima, Japan, 2Hiroshima University, Hiroshima, Japan Purpose/Objective(s): The optimal dose of accelerated hyperfractionated radiation therapy (AHF-RT) for limited-stage small-cell lung cancer (LSCLC) remains unknown. We herein report the assessment of the possibility of escalating the doses of AHF-RT for L-SCLC. Materials/Methods: Between 2006 and 2012, 18 patients diagnosed with L-SCLC and treated with chemotherapy and thoracic radiation therapy (TRT) were enrolled in this study. The chemotherapy regimens were PE (cisplatin and etoposide)- or CE (carboplatin and etoposide)based regimens. Nine patients treated between 2006 and 2010 were irradiated with 45 Gy in 30 fractions for three weeks with AHF. Nine patients treated between 2011 and 2012 were irradiated with 54 Gy in 36 fractions for three and a half weeks with AHF. AHF-RT was given in two phases: patients initially received 36 Gy to the gross tumor plus uninvolved mediastinal nodes, followed by a boost to the gross tumor of nine or 18 Gy. Complete responders received prophylactic cranial irradiation (PCI). All patients were treated with three-dimensional conformal radiation therapy with multiple fields to reduce the irradiated volume of the surrounding tissues, such as the esophagus, as much as possible. Variables related to survival and loco-regional control were estimated by the Kaplan-Meier method, and the Log Rank test was used to evaluate the significance of survival and tumor control, using a p value of 0.05 to indicate significance. The CTCAE v3.0 was used to grade toxicities. Results: The median follow-up of the 45 Gy and 54 Gy groups was 20.2 months (range: 6.3-61.2 months) and 18.5 months (range: 8.1-31.0 months), respectively. No significant differences between the two groups regarding the patients and tumor characteristics were noted. The median duration of TRT was 22 days, ranging from 19-27, in the 45 Gy group, and 28 days, ranging from 22-30, in the 54 Gy group. PCI was administered to four patients (44%) in 45 Gy group, and to eight patients (89%) in the 54 Gy (p Z 0.0790). A comparison between the 45 Gy and 54 Gy groups at two years showed that the overall survival rate was 77.8% vs 33.3%, (p Z 0.2120); the disease free-survival (DFS) was 66.7% vs 0% (p Z 0.0036); the local-regional control was 83.3% vs 30.0% (p Z 0.0812) and the distant metastasis-free survival (DMFS) was 66.7 vs 11.1% (p Z 0.0340). No Grade 3+ non-hematological adverse effects, such as acute esophagitis, pneumonitis or lung fibrosis were encountered. Conclusions: TRT with AHF of 54 Gy with concurrent PE or CE regimens significantly improved the DFS and DMFS control without increasing the toxicity, compared with 45 Gy. Although more patients with longer follow-up periods are needed to fully evaluate the usefulness and safety of this dose escalation of 9 Gy, these outcomes suggest that the dose escalation to 54 Gy on AHF-RT for L-SCLC could be a promising modality to improve the treatment results, with a low incidence of severe toxicity. Author Disclosure: Y. Takeuchi: None. K. Matsuura: None. T. Katsuta: None. T. Okabe: None. M. Kagemoto: None.
3052 Safety and Efficacy of Stereotactic Body Radiation Therapy (SBRT) Reirradiation for New or Recurrent Pulmonary Malignancies Following Previous In-Field Conventionally Fractionated Thoracic Radiation Therapy (CFRT) M. Heskel,1 E.P. Xanthopoulos,2 A.T. Berman,1 W. Levin,1 A. Vachani,1 A. Haas,1 D.H. Sterman,1 A. Lanfranco,1 E. Moon,1 M.N. Corradetti,3 S.M. Hahn,1 K.A. Cengel,1 R. Rengan,4 and C.B. Simone1; 1Hospital of the University of Pennsylvania, Philadelphia, PA, 2Columbia University Medical Center, New York, NY, 3Harvard University Medical School, Boston, MA, 4University of Washington Medical Center, Seattle, WA
Purpose/Objective(s): Delivering a second course of CFRT for recurrence or new malignancies can be associated with considerable toxicity. SBRT is a highly conformal therapy that has become standard treatment for medically inoperable stage I non-small cell lung cancer (NSCLC), but little data exist assessing safety and efficacy of SBRT after definitive CFRT. We assess the feasibility and safety of SBRT following prior in-field CFRT, and we compare patients (pts) treated with SBRT for new primary stage I NSCLC, in-field recurrence of previous NSCLC, or lung metastasis. We hypothesized that SBRT local control (LC) would be high across cohorts but distant metastasis free survival and overall survival (OS) would be lower for pts reirradiated for lung oligometastasis (stage IV disease). Materials/Methods: In this IRB-approved study, we analyzed 40 consecutive pts with 44 lesions retreated with SBRT at our institution between 2/ 2010 and 8/2013 who previously received CFRT and had dose overlap with the SBRT course. Kaplan-Meier and chi square analysis were used to assess LC, nodal and distant failure, and OS. Results: Pts previously received CFRT to a median of 66.6/1.8 Gy (range 45.0-80 Gy/1.5-2.5 Gy) a median of 17.0 months prior to SBRT (range 0.6144.4 months). SBRT was delivered typically to 50 Gy in 4 (peripheral) or 5 (central) fractions for new stage I NSCLC (n Z 23), in-field recurrence of NSCLC (n Z 8; 6 former stage III, 2 former stage I), or new lung metastasis (n Z 13; 8 NSCLC, 5 other primaries). Pts were predominantly female and white (both 65%). Grade 2 chest wall syndrome occurred in 9.1% and pneumonitis in 2.2%. No grade >2 acute or late toxicity was observed. At a median follow-up of 12 months for all pts and 16 months for living pts, LC for the entire cohort was 93% and did not differ according to pt groups (stage I - 91%, recurrence - 88%, stage IV - 100%; p Z 0.48). Nodal failure (entire cohort 14%) did not differ across groups (p Z 0.71). Distant failure was significantly higher in stage IV pts (54%) than in pts with stage I NSCLC (13%) or recurrence (25%) (p Z 0.03). Median OS after SBRT was 42 months and did not differ across cohorts (p Z 0.66). Conclusions: This study demonstrates SBRT can be safely administered in a high-risk pt population previously treated with in-field CFRT. This study also found that SBRT can achieve excellent LC in a variety of reirradiation settings, including for locally-recurrent tumors. Distant failure is the predominant pattern of failure after SBRT reirradiation, particularly among pts treated for stage IV disease. Pulmonary SBRT can be considered as definitive or salvage therapy in well-selected pts with new or recurrent parenchymal lung malignancies. Author Disclosure: M. Heskel: None. E.P. Xanthopoulos: None. A.T. Berman: None. W. Levin: None. A. Vachani: None. A. Haas: None. D.H. Sterman: None. A. Lanfranco: None. E. Moon: None. M.N. Corradetti: None. S.M. Hahn: None. K.A. Cengel: None. R. Rengan: None. C.B. Simone: None.
3053 DART-BID (Differentiated Accelerated Radiation Therapye1.8 Gy Twice Daily) for Locoregionally Advanced NSCLC: Mature Results of a Novel Therapeutic Approach K. Wurstbauer,1 H. Deutschmann,1 F. Zehentmayr,1 C. Fussl,1 K. Dagn,1 P. Kopp,1 P. Porsch,2 B. Maurer,2 M. Blaukovitsch,2 M. Studnicka,2 and F. Sedlmayr1; 1Department of Radiation Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria, 2University Clinic of Pneumology, Paracelsus Medical University Salzburg, Salzburg, Austria Purpose/Objective(s): RTOG 0617, raising the dose from 60 Gy to 74 Gy in a concurrent mode with chemotherapy, failed to improve the results for patients with locoregionally advanced non-small cell lung cancer (NSCLC). Thereafter the potential capacity of concurrent approaches in this entity is challenged. In a prospective study we combined chemotherapy sequentially with accelerated radiation therapy, correlating tumor volume to radiation doses. Primary end point is locoregional tumor control, secondary end points are survival and toxicity. With a median follow-up time of 62.1 months for patients alive, mature results are presented. Materials/Methods: Radiation doses to primary tumors were aligned along increasing tumor size within 4 groups (<2.5 cm/2.5-4.5 cm/4.5-6.0
Volume 90 Number 1S Supplement 2014
3051 45 Gy Versus 54 Gy of Accelerated Hyperfractionated Radiation Therapy for Patients With Limited-Stage Small Cell Lung Cancer: A Retrospective Analysis of a 7-Year Experience Y. Takeuchi,1 K. Matsuura,1 T. Katsuta,1 T. Okabe,2 and M. Kagemoto1; 1 Hiroshima City Hospital, Hiroshima, Japan, 2Hiroshima University, Hiroshima, Japan Purpose/Objective(s): The optimal dose of accelerated hyperfractionated radiation therapy (AHF-RT) for limited-stage small-cell lung cancer (LSCLC) remains unknown. We herein report the assessment of the possibility of escalating the doses of AHF-RT for L-SCLC. Materials/Methods: Between 2006 and 2012, 18 patients diagnosed with L-SCLC and treated with chemotherapy and thoracic radiation therapy (TRT) were enrolled in this study. The chemotherapy regimens were PE (cisplatin and etoposide)- or CE (carboplatin and etoposide)based regimens. Nine patients treated between 2006 and 2010 were irradiated with 45 Gy in 30 fractions for three weeks with AHF. Nine patients treated between 2011 and 2012 were irradiated with 54 Gy in 36 fractions for three and a half weeks with AHF. AHF-RT was given in two phases: patients initially received 36 Gy to the gross tumor plus uninvolved mediastinal nodes, followed by a boost to the gross tumor of nine or 18 Gy. Complete responders received prophylactic cranial irradiation (PCI). All patients were treated with three-dimensional conformal radiation therapy with multiple fields to reduce the irradiated volume of the surrounding tissues, such as the esophagus, as much as possible. Variables related to survival and loco-regional control were estimated by the Kaplan-Meier method, and the Log Rank test was used to evaluate the significance of survival and tumor control, using a p value of 0.05 to indicate significance. The CTCAE v3.0 was used to grade toxicities. Results: The median follow-up of the 45 Gy and 54 Gy groups was 20.2 months (range: 6.3-61.2 months) and 18.5 months (range: 8.1-31.0 months), respectively. No significant differences between the two groups regarding the patients and tumor characteristics were noted. The median duration of TRT was 22 days, ranging from 19-27, in the 45 Gy group, and 28 days, ranging from 22-30, in the 54 Gy group. PCI was administered to four patients (44%) in 45 Gy group, and to eight patients (89%) in the 54 Gy (p Z 0.0790). A comparison between the 45 Gy and 54 Gy groups at two years showed that the overall survival rate was 77.8% vs 33.3%, (p Z 0.2120); the disease free-survival (DFS) was 66.7% vs 0% (p Z 0.0036); the local-regional control was 83.3% vs 30.0% (p Z 0.0812) and the distant metastasis-free survival (DMFS) was 66.7 vs 11.1% (p Z 0.0340). No Grade 3+ non-hematological adverse effects, such as acute esophagitis, pneumonitis or lung fibrosis were encountered. Conclusions: TRT with AHF of 54 Gy with concurrent PE or CE regimens significantly improved the DFS and DMFS control without increasing the toxicity, compared with 45 Gy. Although more patients with longer follow-up periods are needed to fully evaluate the usefulness and safety of this dose escalation of 9 Gy, these outcomes suggest that the dose escalation to 54 Gy on AHF-RT for L-SCLC could be a promising modality to improve the treatment results, with a low incidence of severe toxicity. Author Disclosure: Y. Takeuchi: None. K. Matsuura: None. T. Katsuta: None. T. Okabe: None. M. Kagemoto: None.
3052 Safety and Efficacy of Stereotactic Body Radiation Therapy (SBRT) Reirradiation for New or Recurrent Pulmonary Malignancies Following Previous In-Field Conventionally Fractionated Thoracic Radiation Therapy (CFRT) M. Heskel,1 E.P. Xanthopoulos,2 A.T. Berman,1 W. Levin,1 A. Vachani,1 A. Haas,1 D.H. Sterman,1 A. Lanfranco,1 E. Moon,1 M.N. Corradetti,3 S.M. Hahn,1 K.A. Cengel,1 R. Rengan,4 and C.B. Simone1; 1Hospital of the University of Pennsylvania, Philadelphia, PA, 2Columbia University Medical Center, New York, NY, 3Harvard University Medical School, Boston, MA, 4University of Washington Medical Center, Seattle, WA
Purpose/Objective(s): Delivering a second course of CFRT for recurrence or new malignancies can be associated with considerable toxicity. SBRT is a highly conformal therapy that has become standard treatment for medically inoperable stage I non-small cell lung cancer (NSCLC), but little data exist assessing safety and efficacy of SBRT after definitive CFRT. We assess the feasibility and safety of SBRT following prior in-field CFRT, and we compare patients (pts) treated with SBRT for new primary stage I NSCLC, in-field recurrence of previous NSCLC, or lung metastasis. We hypothesized that SBRT local control (LC) would be high across cohorts but distant metastasis free survival and overall survival (OS) would be lower for pts reirradiated for lung oligometastasis (stage IV disease). Materials/Methods: In this IRB-approved study, we analyzed 40 consecutive pts with 44 lesions retreated with SBRT at our institution between 2/ 2010 and 8/2013 who previously received CFRT and had dose overlap with the SBRT course. Kaplan-Meier and chi square analysis were used to assess LC, nodal and distant failure, and OS. Results: Pts previously received CFRT to a median of 66.6/1.8 Gy (range 45.0-80 Gy/1.5-2.5 Gy) a median of 17.0 months prior to SBRT (range 0.6144.4 months). SBRT was delivered typically to 50 Gy in 4 (peripheral) or 5 (central) fractions for new stage I NSCLC (n Z 23), in-field recurrence of NSCLC (n Z 8; 6 former stage III, 2 former stage I), or new lung metastasis (n Z 13; 8 NSCLC, 5 other primaries). Pts were predominantly female and white (both 65%). Grade 2 chest wall syndrome occurred in 9.1% and pneumonitis in 2.2%. No grade >2 acute or late toxicity was observed. At a median follow-up of 12 months for all pts and 16 months for living pts, LC for the entire cohort was 93% and did not differ according to pt groups (stage I - 91%, recurrence - 88%, stage IV - 100%; p Z 0.48). Nodal failure (entire cohort 14%) did not differ across groups (p Z 0.71). Distant failure was significantly higher in stage IV pts (54%) than in pts with stage I NSCLC (13%) or recurrence (25%) (p Z 0.03). Median OS after SBRT was 42 months and did not differ across cohorts (p Z 0.66). Conclusions: This study demonstrates SBRT can be safely administered in a high-risk pt population previously treated with in-field CFRT. This study also found that SBRT can achieve excellent LC in a variety of reirradiation settings, including for locally-recurrent tumors. Distant failure is the predominant pattern of failure after SBRT reirradiation, particularly among pts treated for stage IV disease. Pulmonary SBRT can be considered as definitive or salvage therapy in well-selected pts with new or recurrent parenchymal lung malignancies. Author Disclosure: M. Heskel: None. E.P. Xanthopoulos: None. A.T. Berman: None. W. Levin: None. A. Vachani: None. A. Haas: None. D.H. Sterman: None. A. Lanfranco: None. E. Moon: None. M.N. Corradetti: None. S.M. Hahn: None. K.A. Cengel: None. R. Rengan: None. C.B. Simone: None.
3053 DART-BID (Differentiated Accelerated Radiation Therapye1.8 Gy Twice Daily) for Locoregionally Advanced NSCLC: Mature Results of a Novel Therapeutic Approach K. Wurstbauer,1 H. Deutschmann,1 F. Zehentmayr,1 C. Fussl,1 K. Dagn,1 P. Kopp,1 P. Porsch,2 B. Maurer,2 M. Blaukovitsch,2 M. Studnicka,2 and F. Sedlmayr1; 1Department of Radiation Oncology, Paracelsus Medical University Salzburg, Salzburg, Austria, 2University Clinic of Pneumology, Paracelsus Medical University Salzburg, Salzburg, Austria Purpose/Objective(s): RTOG 0617, raising the dose from 60 Gy to 74 Gy in a concurrent mode with chemotherapy, failed to improve the results for patients with locoregionally advanced non-small cell lung cancer (NSCLC). Thereafter the potential capacity of concurrent approaches in this entity is challenged. In a prospective study we combined chemotherapy sequentially with accelerated radiation therapy, correlating tumor volume to radiation doses. Primary end point is locoregional tumor control, secondary end points are survival and toxicity. With a median follow-up time of 62.1 months for patients alive, mature results are presented. Materials/Methods: Radiation doses to primary tumors were aligned along increasing tumor size within 4 groups (<2.5 cm/2.5-4.5 cm/4.5-6.0