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Survival in patients with non-small cell lung cancer and brain metastases
S32 radiotherapy regimen in routine practice. However, further improvements are needed to gain better local control and outcomes for various (chemo-) radiotherapy fractionations need to be directly compared in the setting of a randomised controlled trials. Reference(s) Price A. Results of a survey of UK clinical oncologists. Presented at the Medical Research council; 2001. 97 Survival in patients with non-small cell lung cancer and brain metastases M. Thit Lwin, K. Bradley, S. Wright, V. Laurence. Poole General Hospital, Dorset, United Kingdom Purpose: The QUARTZ (Quality of Life After Radiotherapy and Steroids) trial is a prospective randomised controlled trial seeking to answer the question of whether OSC (optimal supportive care including dexamethasone) is as effective as OSC and WBRT in terms of patient-assessed Quality Adjusted Life Years with NSCLC and inoperable brain metastases. Overall survival is a secondary end point. We report our centre’s experience of recruiting to QUARTZ and the outcomes of patients who were not recruited due to lack of Clinician/Patient uncertainty of the role of WBRT (inclusion criteria). We postulate that an experienced oncologist will appropriately select good prognosis patients for WBRT. Patients and Methods: All patients presenting with brain metastases from NSCLC from September 07 to September 09 were considered for recruitment to QUARTZ. If ineligible they received WBRT or no WBRT according to the clinician’s recommendation and patient’s choice.
Posters, 8th Annual BTOG Conference, 2010 Median survivals in the four different groups were 52 weeks in WBRT followed by systemic treatment group, 18 weeks in WBRT alone, 10 weeks in systemic treatment group and 5 weeks in the group of OSC. Conclusion: As with other trials of “treatment or no treatment”, QUARTZ was difficult to recruit to. There was clinician uncertainty of the role of WBRT in a minority of cases. An experienced clinician appropriately judges prognosis when considering the role of WBRT for patients with brain metastases from NSCLC. 98 Defining target volumes for treatment of peripheral lung tumours with radiotherapy: A comparison of 18F-FDG-positron emission tomography and 4-dimensional CT scanning ornsen de Koste1 , M. Dahele1 , K. Carson2 , G.G. Hanna1 , R. Van S¨ 1 C.J.A. Haasbeek , R. Migchielsen1 , A. Hounsell3 , S. Senan1 . 1 VU University Medical Center, Amsterdam, Netherlands, 2 Royal Victoria Hospital, Belfast, N Ireland, United Kingdom, 3 Cancer Centre, Belfast City Hospital, N Ireland, United Kingdom Introduction: High local control rates are achieved in stage I lung cancer using stereotactic radiotherapy (SRT). Target definitions are commonly based on four-dimensional (4D) computed tomography (CT) scans. Previous phantom data has suggested that positron emission tomography (PET) may be useful in compensating for tumour motion when defining target volumes (TVs) in lung cancer. Using both phantom and clinical data we compare the TVs defined by both 4DCT and PET/CT. Methods: Conventional three-dimensional PET/CT scans were acquired of a motion phantom equipped with a 3 cm 18F-FDGfilled sphere, during periodic motion (4 seconds, 1.5 cm peakto-peak motion amplitude) and a 4DCT scan during the same motion. In 7 patients with stage I NSCLC, imaged with both PET/CT and 4DCT, 6 approaches for deriving PET-TVs were evaluated, including manually contouring, standardized uptake value (SUV) absolute threshold of 2.5, 35% of maximum SUV (35%SUVMAX), 41% of SUVMAX (41%SUVMAX) and two different source-to-background ratio techniques (SBR1 and SBR2). Following deformable registration, the former were compared to a 4DCT-based gross tumour volume (GTV) and maximum intensity projection-based TVs (MIP-ITV). Volumetric and positional correlation was assessed using the dice coefficient (DC). Results: Phantom study: PET volumes did not correspond in size or shape to MIP-ITV regardless of threshold used. Patients: PETbased TVs did not correspond to 4DCT-based TVs. Mean DC with respect to 4DCT-based GTV was: PET Manual = 0.69, SUV2.5 = 0.72, 35%SUVMAX = 0.70, 41%SUVMAX = 0.69. SBR1 = 0.60, SBR2 = 0.59. The mean DC relative to MIP-TV were: PET Manual = 0.68, SUV2.5 = 0.71, 35%SUVMAX = 0.67, 41%SUVMAX = 0.61. SBR1 = 0.52, SBR2 = 0.51. PET-based TVs were smaller than corresponding MIP-ITVs. Conclusions: As the conventional PET based TVs did not correspond to 4DCT-based TVs that are commonly used in SRT, PET alone should not be relied upon for GTV edge definition or tumour motion compensation in stage I lung cancer. 99 RADAR Radiation damage and resistance in patients with lung cancer
Survivals of patients with brain metastases from NSCLC in four different management groups. Results: Twenty-nine patients were considered for QUARTZ. 15 (52%) were excluded as their clinician felt WBRT was indicated. A further 10 (34%) were excluded as their clinician judged WBRT not to be indicated. Four patients (14%) were offered participation. None of these entered the trial as they all had an opinion of whether or not they wished to receive WBRT. Thus, none of the 29 patients was recruited.
P.K. Koh1 , E. Dean2 , I. Trigonis3 , A. Jackson4 , C. Faivre-Finn1 , F.H. Blackhall2 . 1 Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, 2 Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, 3 Clinical Fellow, Wolfson Molecular Imaging Centre, Manchester, United Kingdom, 4 Radiology, Wolfson Molecular Imaging Centre, Manchester, United Kingdom Background: Thoracic radiotherapy is commonly used in the treatment of inoperable non-small cell lung cancer (NSCLC) and
Posters, 8th Annual BTOG Conference, 2010 Median survivals in the four different groups were 52 weeks in WBRT followed by systemic treatment group, 18 weeks in WBRT alone, 10 weeks in systemic treatment group and 5 weeks in the group of OSC. Conclusion: As with other trials of “treatment or no treatment”, QUARTZ was difficult to recruit to. There was clinician uncertainty of the role of WBRT in a minority of cases. An experienced clinician appropriately judges prognosis when considering the role of WBRT for patients with brain metastases from NSCLC. 98 Defining target volumes for treatment of peripheral lung tumours with radiotherapy: A comparison of 18F-FDG-positron emission tomography and 4-dimensional CT scanning ornsen de Koste1 , M. Dahele1 , K. Carson2 , G.G. Hanna1 , R. Van S¨ 1 C.J.A. Haasbeek , R. Migchielsen1 , A. Hounsell3 , S. Senan1 . 1 VU University Medical Center, Amsterdam, Netherlands, 2 Royal Victoria Hospital, Belfast, N Ireland, United Kingdom, 3 Cancer Centre, Belfast City Hospital, N Ireland, United Kingdom Introduction: High local control rates are achieved in stage I lung cancer using stereotactic radiotherapy (SRT). Target definitions are commonly based on four-dimensional (4D) computed tomography (CT) scans. Previous phantom data has suggested that positron emission tomography (PET) may be useful in compensating for tumour motion when defining target volumes (TVs) in lung cancer. Using both phantom and clinical data we compare the TVs defined by both 4DCT and PET/CT. Methods: Conventional three-dimensional PET/CT scans were acquired of a motion phantom equipped with a 3 cm 18F-FDGfilled sphere, during periodic motion (4 seconds, 1.5 cm peakto-peak motion amplitude) and a 4DCT scan during the same motion. In 7 patients with stage I NSCLC, imaged with both PET/CT and 4DCT, 6 approaches for deriving PET-TVs were evaluated, including manually contouring, standardized uptake value (SUV) absolute threshold of 2.5, 35% of maximum SUV (35%SUVMAX), 41% of SUVMAX (41%SUVMAX) and two different source-to-background ratio techniques (SBR1 and SBR2). Following deformable registration, the former were compared to a 4DCT-based gross tumour volume (GTV) and maximum intensity projection-based TVs (MIP-ITV). Volumetric and positional correlation was assessed using the dice coefficient (DC). Results: Phantom study: PET volumes did not correspond in size or shape to MIP-ITV regardless of threshold used. Patients: PETbased TVs did not correspond to 4DCT-based TVs. Mean DC with respect to 4DCT-based GTV was: PET Manual = 0.69, SUV2.5 = 0.72, 35%SUVMAX = 0.70, 41%SUVMAX = 0.69. SBR1 = 0.60, SBR2 = 0.59. The mean DC relative to MIP-TV were: PET Manual = 0.68, SUV2.5 = 0.71, 35%SUVMAX = 0.67, 41%SUVMAX = 0.61. SBR1 = 0.52, SBR2 = 0.51. PET-based TVs were smaller than corresponding MIP-ITVs. Conclusions: As the conventional PET based TVs did not correspond to 4DCT-based TVs that are commonly used in SRT, PET alone should not be relied upon for GTV edge definition or tumour motion compensation in stage I lung cancer. 99 RADAR Radiation damage and resistance in patients with lung cancer
Survivals of patients with brain metastases from NSCLC in four different management groups. Results: Twenty-nine patients were considered for QUARTZ. 15 (52%) were excluded as their clinician felt WBRT was indicated. A further 10 (34%) were excluded as their clinician judged WBRT not to be indicated. Four patients (14%) were offered participation. None of these entered the trial as they all had an opinion of whether or not they wished to receive WBRT. Thus, none of the 29 patients was recruited.
P.K. Koh1 , E. Dean2 , I. Trigonis3 , A. Jackson4 , C. Faivre-Finn1 , F.H. Blackhall2 . 1 Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, 2 Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom, 3 Clinical Fellow, Wolfson Molecular Imaging Centre, Manchester, United Kingdom, 4 Radiology, Wolfson Molecular Imaging Centre, Manchester, United Kingdom Background: Thoracic radiotherapy is commonly used in the treatment of inoperable non-small cell lung cancer (NSCLC) and