Volume 90 � Number 5S � Supplement 2014 Poster Presentations S25
(50% drop, 75% drop, @ 3 cutoffs) was the same in the 2 dose groups.
Median survival was 50 months for the entire cohort, with a 2- & 5- year
survival of 88%, 65%. DE-RT pts have not yet achieved median survival.
The 2-year DFS was 70% (37 mo median DFS). None of the factors
including RT dose, T down staging, MNC, different cut off points for
SUV drop were significant for outcomes on DFS, OS. At last follow-up,
17 pts (46%) were free of disease and 14 alive (38%).
Conclusions: RT dose escalation resulted in improvement in MNC and
correlated with the PET response in our series. Long-term follow-up and
larger pt numbers are needed for the DE-RT pts to prove the concept.
PET response can be utilized as predictor of outcomes in operable
NSCLC pts.
Author Disclosure: A. Turaka: None. S. Hasan: None. T. Li: None. R.
Mehra: None. W.J. Scott: None. J.Q. Yu: None.
146Accelerated Hypofractionated Radiation Therapy PlusChemotherapy for Inoperable Locally Advanced Lung Cancer: FinalResults of Long-term Follow-upLocally Advanced Non-Small Cell Lung CancerE. Parisi,1 G. Genestreti,2 A. Romeo,1 M. Romagnoli,3 M. Burgio,1
G. Ghigi,1 D. Arpa,1 A. Sarnelli,1 A. Tesei,1 and R. Polico1; 1Istituto
Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS,
Meldola, Italy, 2Ospedale Bellaria, Bologna, Italy, 3Ospedale Morgagni-
Pierantoni, Forlı̀, Italy
Purpose/Objective(s): We previously reported the feasibility and
acute toxicity of full-dose chemotherapy and accelerated hypo-
fractionated radiation therapy in inoperable locally advanced non-
small cell lung cancer (NSCLC). In this report, we present the
long-term results of inoperable locally advanced NSCLC patients
treated with high dose radiation therapy and full-dose chemotherapy
(IRST protocol 162.01). The study was approved by our Medical and
Scientific Committee.
Materials/Methods: Treatment consisted of 2 cycles of induction
chemotherapy (cisplatin/docetaxel), accelerated hypofractionated radia-
tion therapy, and a further 2 cycles of consolidation chemotherapy. All
patients had clinically documented stage IIIA (19%) or IIIB (81%)
NSCLC confirmed by fine needle aspiration biopsy (FNAB), bronchos-
copy, or transbronchial needle aspiration (TBNA). CT and CT/PET scans
were used for initial staging and for restaging after completion of
treatment. A bronchoscopy was performed before induction chemo-
therapy and after radiation therapy. The dose prescribed was 30 Gy/5
daily fractions at the reference isodose (60%-70%) with an increasing
dose inhomogeneity of up to 40 Gy inside the tumor, and 25 Gy/5 daily
fractions at the reference isodose, with an increasing dose inhomogeneity
of up to 37.5 Gy in the clinically involved lymph nodes. We analyzed
overall survival, local progression-free survival, locoregional control, and
long-term toxicity.
Results: Of the 23 patients enrolled onto the study between January 2009
and January 2012, 19 were evaluable. The median follow up was 39
months (range 2-56). Median overall survival (OS) was 23 months (95%
CI 9.6-55.5), median local progression-free survival was 19.8 months
(95% CI 9.7-not reached), and median metastasis-free survival was 9.7
months (95% CI 5.8-46.0). At the end of the study, 47% of patients were
downstaged and 1 patient underwent surgery. No late grade 3/4 toxicity
from radiation therapy was observed. Accrual was closed before the target
sample size was met.
Conclusions: Our results show that accelerated hypofractionated radiation
therapy and full dose chemotherapy was possible without high-grade
toxicity. In particular, a week-long treatment using accelerated hypo-
fractionated radiation therapy in inoperable locally advanced lung cancer
was reasonably well tolerated. We also demonstrated that accelerated
hypofractionation for central primary tumor volumes (T3, T4) and medi-
astinal lymph node stations can be administered without causing severe
acute and late side-effects. No grade 3/4 for late toxicity was recorded. The
median OS of 23 months for IIIB lung cancer compares favorably with
literature data.
Author Disclosure: E. Parisi: None. G. Genestreti: None. A. Romeo:
None. M. Romagnoli: None. M. Burgio: None. G. Ghigi: None. D.
Arpa: None. A. Sarnelli: None. A. Tesei: None. R. Polico: None.
147WITHDRAWN
148WITHDRAWN
149Prognostic Biomarkers in Non-Small Cell Lung Cancer PatientsTreated With Radiation TherapyLocally Advanced Non-Small Cell Lung Cancer
S. Kumar,1 B. Movsas,2 S.L. Brown,2 M. Simoff,2 C.H. Stone,2
K.A. Jenrow,2 K. Lapanowski,2 M. Ajlouni,2 I.J. Chetty,2 A. Movsas,3
M. Lu,2 A. Sitarik,2 L. Lamerato,2 M.R. Jones,4 Z. Hammoud,2
N. Peshkin,2 K. Roszka,2 and R. Parry5; 1Henry Ford Health System,
Detroit, MI, 2Henry Ford Health System, Detroit, MI, 3University of
Michigan, Ann Arbor, MI, 4Oakland University, Rochester, MI, 5Varian
Medical Systems, San Francisco, CA
Purpose/Objective(s): To determine specific tumor biomarkers predicting
radiation therapy response in non-small cell lung cancer (NSCLC)
patients.
Materials/Methods: Tumors from NSCLC patients (nZ133) treated with
curative radiation therapy alone or combined with chemotherapy (initially
presenting with stage I, II, or III disease comprising 21%, 15%, and 64% of
patients, respectively) were examined for the following 8 biomarkers:
ALDH1A1, CD68, Hyaluronic acid, Beta-Catenin, CD44, MFG-E8, Matrix
metalloproteinase-9 (MMP-9) and Vimentin, as a control. The markers were
selected based on their correlationwith TGF-beta expression and/or association
with tumor aggressiveness, radioresistance, and poor prognosis in several tumor
indications. Survival time was calculated using a Cox proportional hazards
model. Univariate analyses followed by multivariate models were examined to
determine biomarkers and other factors predictive of survival. A logistic
regression model was used to analyze factors predicting for local control.
Results: HighCD68 expressionwas associatedwith an increased risk of death(PZ.008), while therewas a trend towards a decreased risk of death associated
with high MMP-9 expression (PZ.05). Squamous cell carcinoma histology
was associated with higherodds of local failure compared to adenocarcinoma
[Odds ratio, [OR] Z 4.39, 95% confidence interval [CI] Z 0.96-19.98).
Expression of CD44 was associated with significantly increased odds of local
tumor failure (OR Z 1.44, 95% CI Z 1.08-1.92), while MFG-E8 was asso-
ciatedwith decreased odds of local tumor failure (ORZ 0.77, 95%CIZ 0.62-
0.97). Combined, CD44, MFG-E8, and tumor type were predictive of local
control with an area under the curve value of 0.74 (1.00 being a perfect pre-
dictor). The median survival time among all patients was 1.5 years. The only
patient characteristic on univariate model analyses exhibiting a difference in
survivalwas race,withAfrican-Americans (AA) having a 1.5 times greater risk
of death than non-AA (PZ.044), while the overall effect of race on survival
was not significant (PZ.76). The overall main effect of median household
income remained insignificant (PZ.099), as in the univariate analysis. How-
ever, after checking for effect modification, the median household income
significantly modified the effect of race on survival (PZ.037), and that model
fit was improved. AA were only at a significantly higher risk when median
household income was between $30,000 and $50,000 (PZ.002).
Conclusions: Among the NSCLC treated with radiation therapy, CD68
was predictive of increased risk of death, while MMP-9 decreased the risk
of death. Racial disparities in survival were dependent on median house-
hold income. High expression of CD44 and low expression of MFG-E8
were predictive of local tumor control.
Author Disclosure: S. Kumar: None. B. Movsas: E. Research Grant;
Varian Medical Systems. S.L. Brown: E. Research Grant; Varian Medical