Stereotactic Fractionated Radiotherapy (SRT) for Intra-Thoracic Tumours

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I. J. Radiation Oncology

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● Biology ● Physics

Volume 63, Number 2, Supplement, 2005

Stereotactic Fractionated Radiotherapy (SRT) for Intra-Thoracic Tumours

H. Van Parijs, J. Van de Steene, V. Vinh-Hung, D. Van Den Berge, D. Verellen, G. Storme Oncologisch Centrum, AZ-VUB, Jette, Brussels, Belgium Purpose/Objective: To evaluate tumour response, acute and late toxicity, following stereotactic radiotherapy (SRT) of primary lung cancer and lung metastases. Materials/Methods: Records of 42 patients who received SRT for intrathoracic tumours between July 2001 and May 2004 and who had their follow up at the same institute (AZ-VUB) were reviewed. The patient characteristics were: 30 male, 12 female; mean age 65 (range: 32–92) years; 25 primary lung cancer (22 NSCLC, 1 SCLC, 1 melanoma, 1 sarcoma; 11 stage I-II, 12 stage III-IV) and 17 lung metastasis from other primary cancers. Treatment planning was performed with image fusion of CT and FDG-PET scan. Treatment was delivered with X-ray image guidance (IGRT). IGRT was based on fiducial metallic markers (Fibered Platinum Coil, Boston Scientific/Target Therapeutics, Fremont, CA) implanted intra-tumouraly in 16 cases. IGRT was based on bone structures in the other 26 patients. The mean total doses delivered were 74.2 2 Gy-EQD for primary lung cancer and 63.7 Gy for lung metastasis. PTV was enclosed by the 95%-isodose. The PTV-margins were 4 – 8 mm in case of markers, 10 –12 mm without marker. Pre- and post- SRT lung function evaluation was performed in 22 patients. Results: With a median follow-up of 14 months, there were 21 (50.0%) complete responses, 15 (35.7%) partial responses and 3 (7.1%) patients with stable disease. The observed local recurrence free survival was 54% at 21 months. In the lung primary group the cause specific survival after 12 and 24 months was 94.1 and 84.7% (for T1-T2 tumours 100% each). Local tumour control was 68.0%. In the metastasis group, local tumour control was 76.5%. Acute side effects were mild. There was no grade 3– 4 toxicity. 18 patients had a mild cough, 5 had grade 1 and another 5 had grade 2 pneumonitis, most patients experienced no acute toxicity. As late complications we observed grade 3 dyspnoe (1 case), grade 1 pain (2 cases) and grade 1 dysphagia (1 case). Lung function parameters decreased at 3 months after SRT but recovered at 12 months (see figure). Conclusions: In this single institution study, SRT was associated with high local control rate and with good cause specific survival. There was little major toxicity and lung function was preserved.

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PET-CT for Patients (pts) Selection within a Multimodality Treatment Protocol (CTx ⴙ CTx/RTx ⴞ S) in Pts with Locally Advanced (LAD) Non-Small Cell Lung Cancer (NSCLC)(Inoperable Stage IIIA/Selected IIIB)

M. Stuschke,1 C. Poettgen,1 T. Gauler,2 S. Korfee,2 S. Bildat,2 A. Goehlert,1 G. Stamatis,4 T. Krbek,4 H. Teschler,4 A. Bockisch,3 W. Eberhardt2 1 Radiotherapy, University Duisburg-Essen, Essen, Germany, 2Internal Medicine (Cancer Research), University DuisburgEssen, Essen, Germany, 3Nuclear Medicine, University Duisburg-Essen, Essen, Germany, 4Ruhrlandklinik, Essen, Germany Purpose/Objective: Multimodality treatment protocols (CTx/RTx ⫾ S) are currently the most intensive curative treatment approaches for LAD-NSCLC stage III patients (pts). In this setting, adequate pts selection based on detailed co-morbidity profiles as well as accurate disease staging is of highest priority. Here we describe our single center experience in Essen with PET-CT as a staging/selection tool for pts treated within a large prospectively randomized multicenter German trial. Materials/Methods: Within our prospectively randomized multicenter trial, pts with LAD-NSCLC are planned for 3 cycles induction chemotherapy (CTx) (cisplatin (P) 50 mg/m2, d1⫹8, and paclitaxel 175 mg/m2 d1, qd 21) followed by concurrent (cc) chemoradiotherapy (CTx/RTx) (accelerated-hyperfractionated, 45 Gy, 2⫻1.5 Gy/d, plus P 50 mg/m2, d2⫹9 of RT, and vinorelbine (Nav) 20 mg/m2, d 2⫹9). Staging mediastinoscopy is mandatory in all patients. Our center has investigated PET-CT both for initial staging evaluation as well as for response assessment following induction-CTx and following cc CTx/RTx. Within the trial, pts are further assessed for resectability after 45 Gy. Resectable pts (interdisciplinary treatment panel) are randomized to either definitive CTx/RTx boost (arm A: boost 20 –26 Gy, 2 Gy qd, cc CTx: P 40 mg/m2, d2 of boost-RTx, and Nav 15 mg/m2, d 2 ⫹ 9) or to surgical resection (S) (arm B). Results: Between January 2004 and March 2005, 76 pts have been screened at the West German Cancer Center alone for eligibility to trials participation. Four patients have not been enrolled based on their co-morbidity profile (weight loss, recent myocardial infarction or thromboembolic events), 23 pts due to up-staging, mainly based on initial PET-CT findings (22 pts). In 6 pts an unexpected involvement of supraclavicular lymph nodes only (N3-sclav) was detected; 12 pts had proven distant metastases; 5 pts had simultaneous lymph node (N3-sclav) as well as distant metastases. So far, in our center 49/76 pts have