Esophageal and brachial plexus dose were limited to a point Dmax of 48 Gy and 42 Gy, respectively. Overlap of PTV with central airways was accepted. Patients ...
Volume 84 Number 3S Supplement 2012 and gross pathologic tumor size (rZ0.916, p 0.05). Significant improvement in the mean scores of airway symptoms (p < 0.05) was achieved equally in both arms as reported by patients using LC13. Hemoptysis had the highest improvement rate in 100% of patients in both groups followed by chest pain, cough, and dyspnea with improvement rates ranging from 60-73.3%. According to clinicians’ symptom assessment, improvement of symptoms meant a 1 step decrease in Symptom’s grade. Hemoptysis again had the highest improvement rate of 100% in both groups followed by chest pain, dyspnea, and cough with improvement rates ranging from 60-71.4%. Treatment was well tolerated in both groups. Dysphasia was considered the main side effect with RTOG grade 3 toxicity seen in one patient (6.7%), and in 2 patients (13.3%) of group A and B, respectively. No other RTOG toxicities of grades 3 were noted. Quality of life was preserved equally in both groups with no significant differences in the mean scores of QLQ-30 (all p >0.05) at any time point. No significant difference in the overall survival was seen, with median survival of 5 and 6 months in group A and B, respectively (KM pZ 0.55). Conclusions: The explored hypofractionated regimen was feasible, less expensive, and more convenient for patients with symptomatic advanced
Poster Viewing Abstracts S549 disease and limited expected survival versus the standard regimen. It also proved to be equally effective in terms of palliative effect, treatment tolerance, quality of life, and overall survival. Author Disclosure: A. Mohamed: None. N.A. Eldeeb: None. A.M. Belal: None. A. Ganady: None.
2882 Predicting Symptomatic Radiation Pneumonitis After Concurrent Chemoradiation Therapy for Non-small Cell Lung Cancer: Results of an International Individual Patient Data Meta-analysis D.A. Palma,1 S. Senan,2 K. Tsujino,3 R.B. Barriger,4 R. Rengan,5 M. Moreno,6 J.D. Bradley,7 T. Hyun Kim,8 L.B. Marks,9 G. Rodrigues,1et al.; 1London Regional Cancer Program, London, ON, Canada, 2VU University Medical Center, Amsterdam, Netherlands, 3Hyogo Cancer Center, Hyogo, Japan, 4Indiana University School of Medicine, Indianapolis, IN, 5University of Pennsylvania, Philadelphia, PA, 6Clı´nica Universidad de Navarra, Pamplona, Spain, 7 Washington University School of Medicine, St. Louis, MO, 8National Cancer Center, Goyang, Korea, Democratic People’s Republic of, 9 University of North Carolina, Chapel Hill, NC Purpose/Objective(s): Radiation pneumonitis is a dose-limiting toxicity for patients undergoing concurrent chemoradiation therapy (CCRT) for non-small cell lung cancer (NSCLC). We performed an individual patient data meta-analysis to determine factors predictive of clinically significant pneumonitis. Materials/Methods: After a systematic review of the literature, data was obtained on 836 patients who underwent CCRT in Europe, North America and Asia. Patients were randomly divided into training and validation sets (2/3 vs. 1/3 of patients). Factors predictive of symptomatic or fatal pneumonitis were evaluated using logistic regression. Recursive partitioning analysis (RPA) was used to define risk groups. Results: The median radiation therapy dose was 60 Gy, and median follow-up was 2.3 years. Most patients received concurrent cisplatin/ etoposide (38%) or carboplatin/paclitaxel (26%). The overall rate of symptomatic pneumonitis was 29.8% (nZ249), with fatal pneumonitis in 1.9% (nZ16). In the training set, factors predictive of symptomatic pneumonitis were lung volume receiving 20 Gy (V20) [OR:1.03 per 1% increase, pZ0.008], and carboplatin/paclitaxel chemotherapy [OR:3.33, p0.65). On RPA, the highest risk of pneumonitis (>50%) was in patients >65 years of age receiving carboplatin/paclitaxel. Predictors of fatal pneumonitis were daily dose >2 Gy, V20, and lower-lobe tumor location. Conclusions: Several modifiable risk factors predict the development of symptomatic pneumonitis, and elderly patients who undergo CCRT with carboplatin-paclitaxel chemotherapy are at highest risk. Fatal pneumonitis, although uncommon, is related to dosimetric factors and tumor location. Funding: Ontario Institute for Cancer Research (DP) and in part by National Institutes of Health Grant CA69579 (LBM) Author Disclosure: D.A. Palma: None. S. Senan: E. Research Grant; Sanofi Aventis. K. Tsujino: None. R.B. Barriger: None. R. Rengan: None. M. Moreno: None. J.D. Bradley: None. T. Hyun Kim: None. L.B. Marks: None. G. Rodrigues: None.
2883 Hypofractionated Stereotactic Radiation Therapy for Large and Central Lung Tumors E. Bongers, M.R. Dahele, C.J. Haasbeek, P.F. de Haan, W.F. Verbakel, B.J. Slotman, and S. Senan; VU University Medical Center, Amsterdam, Netherlands Purpose/Objective(s): High local control rates have been reported for central lung tumors treated using stereotactic radiation therapy (SABR) delivered using 8 fractions of 7.5 Gy. More centrally located tumors (e.g. PTV overlapping esophagus or carina), and PTVs >200 cc were previously
S550
International Journal of Radiation Oncology Biology Physics
not considered suitable. We introduced a risk-adapted scheme delivering 60 Gy in 12 fractions, with under-dosing of PTV accepted in order to meet organ at risk (OAR) constraints. We report early outcomes with this approach. Materials/Methods: Between 2009 and 2011, 49 patients (50 PTVs) were treated with the 12 x 5 Gy scheme (4 fractions/week) prescribed to 95% of the PTV (maximum dose 140%). Forty-three patients (88%) were treated for lung cancer (32 N0, 8 N1, 3 N2-3), 2 (4%) for nodal recurrence (N2-3) and 4 (8%) for metastatic disease. After multidisciplinary evaluation, the reasons for not receiving standard surgery or chemoradiation therapy included comorbidity (53%), metastases (14%), prior pneumectomy or bilobectomy (12%), bilateral tumors (8%) and patient refusal (8%). 4DCT planning was performed with 5mm ITV-PTV margins, VMAT, and online CBCT tumor setup. Esophageal and brachial plexus dose were limited to a point Dmax of 48 Gy and 42 Gy, respectively. Overlap of PTV with central airways was accepted. Patients underwent post-treatment follow-up visits and CT scans at 3, 6, 12 and 24 months post-SABR. Toxicity was scored using CTCAE v4.03. Results: The median follow-up was 6.8 months (0.7-22.2). Median PTV volume was 105cc (10 - 411cc). PTV was
