conflict of interest declaration: nothing to disclose presenter: sophie lamoureux title of...
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Conflict of Interest Declaration: Nothing to Disclose
Presenter: Sophie Lamoureux
Title of Presentation: A Comparison of Stereotactic Body Radiotherapy with Hypofractionated Radiotherapy for Early Stage Non-small Cell Lung Cancer: Control Rates from a Regional Cancer Centre
I have no financial or personal relationships to disclose
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Technologies:
- Four Dimensional CT Simulation
- Integrated PET planning
- Conformal Radiation Therapy
- On board Cone Beam CT
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45 pts
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NECC SABR
- 48Gy in 4 fractions
- VMAT Planning
- SABR Tumor Board
- Patient Selection
• Medically inoperable
• T1 or T2 <5cm
• Biopsy proven or suspected NSCLCa
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NECC SABR Database
Baseline demographics
• T Stage
• Size
• Biopsy results
• PET results
• PFT
• Dosimetry
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NECC SABR Database
Follow up data – q3mos initially
• Performance Status
• Survival / Cause of death
• Lesional control
• Regional control
• Distant control
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NECC SABR Database
Follow up data – CTCAE 4.02
• Chest wall pain
• Esophagitis
• Pneumonitis
• Pulmonary Hemorrhage
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Patients
- 54 Patients were treated with 4800/12
- 26 Patients were treated with 5200/13
- 28 Patients were treated with 6000/15
- 76 Patients were treated with SABR of which 33 were peripheral lesions treated with 4800/4
Central lesions treated with 6000/8 were not analysed. Metastatic lesions are not included in this analysis.
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Hypofractionation Toxicity
No Data collected
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SABR Toxicity
Symptomatic Pneumonitis 0
Pulmonary Hemmorhage 0
Symptomatic Chest Wall Pain 1
Symptomatic Esophagitis 0
33 evaluable patients, Median follow up 245 Days
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NECC Hypofractionated DemographicsTable 1. Demographics of early stage lung cancer patients treated with
hypofractionated RT at the NECC
Characteristic Value
No. of patients 108
Median age (in years) 80 (56-99)
Status
Alive 43.5%
Deceased 56.5%
Gender
Female 40.7%
Male 59.3%
Median diameter (in cm) 2.95 (1.0-7.3)
Dose (in cGy)/fraction
4800/12 50.0%
5200/13 24.1%
6000/15 25.9%
PET Scan
Yes 46.1%
No 53.9%
Bone Scan
Yes 63.7% No 36.3%CT Head
Yes 63.7%
No 36.3%
MRI Head
Yes 6.9%
No 93.1%
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Overall Survival (Hypofraction)
0.0
00
.25
0.5
00
.75
1.0
0
0 500 1000 1500 2000 2500analysis time
F M
Kaplan-Meier survival estimates
(days)
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Lesional Control (Hypofraction)
0.0
00
.25
0.5
00
.75
1.0
0
0 500 1000 1500 2000 2500analysis time
F M
Kaplan-Meier survival estimates
(days)
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0.0
00
.25
0.5
00
.75
1.0
0
0 500 1000 1500 2000 2500analysis time
F M
Kaplan-Meier survival estimates
(days)
Regional Disease (Hypofraction)
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Metastatic Disease (Hypofraction)
0.0
00
.25
0.5
00
.75
1.0
0
0 500 1000 1500 2000 2500analysis time
F M
Kaplan-Meier survival estimates
(days)
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Regional Disease (Hypofraction)
0.0
00
.25
0.5
00
.75
1.0
0
0 500 1000 1500 2000 2500analysis time
4800/12 5200/136000/15
Kaplan-Meier survival estimates
(days)
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Metastatic Disease (Hypofraction)
0.0
00
.25
0.5
00
.75
1.0
0
0 500 1000 1500 2000 2500analysis time
4800/12 5200/136000/15
Kaplan-Meier survival estimates
(days)
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Overall Survival0
.00
0.2
50
.50
0.7
51
.00
0 500 1000 1500 2000 2500analysis time
4800/12 4800/45200/13 6000/15
Kaplan-Meier survival estimates
Pr>chi2 = 0.1961 chi2(3) = 4.69
Total 65 65.00 6000/15 6 9.335200/13 13 16.734800/4 4 5.204800/12 42 33.74 Treatmentr~d observed expected Events Events
Log-rank test for equality of survivor functions
(days)
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Lesional Control0
.00
0.2
50
.50
0.7
51
.00
0 500 1000 1500 2000 2500analysis time
4800/12 4800/45200/13 6000/15
Kaplan-Meier survival estimates
Pr>chi2 = 0.2314 chi2(3) = 4.29
Total 26 26.00 6000/15 3 5.145200/13 5 7.074800/4 2 2.924800/12 16 10.87 Treatmentr~d observed expected Events Events
Log-rank test for equality of survivor functions
(days)
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Conclusion
Radiotherapy for early stage lung cancer has advanced significantly at NECC.
As of Feb 2015, over 76 SABR treatments have been delivered and 108 hypofractionated radiotherapy treatments.
There is a non-significant trend towards improved lesional control with higher doses of RT with no change in regional control, development of metastatic disease, survival or toxicity.