Purpose/Objective(s): Recent studies have suggested a significant variation in radiotherapy schedules used to treat advanced. NSCLC, both between different ...
I. J. Radiation Oncology d Biology d Physics
S464
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Volume 75, Number 3, Supplement, 2009
Treatment Strategies in Radiotherapy for Advanced Non–small Cell Lung Cancer: Differences in Attitude in Europe
I. Chalimou1, H. Lind2, P. Mavroidis3, G. Sakellaropoulos4, G. Nikiforidis4, N. Papanikolaou5, B. Lind3 University of Pat, Patras, Greece, 2Karolinska University Hospital, Stockholm, Sweden, 3Karolinska Institutet and University of Stockholm, Stockholm, Sweden, 4University of Patras, Patras, Greece, 5UTHSCSA, San Antonio, TX 1
Purpose/Objective(s): Recent studies have suggested a significant variation in radiotherapy schedules used to treat advanced NSCLC, both between different centers as well as between countries. The purpose of this study is to investigate the range of treatment strategies for advanced NSCLC within Europe. Materials/Methods: In this study, treatment methodologies have been explored using management plans proposed by radiation oncologists regarding given general questions and theoretical case histories for patients with advanced NSCLC. A postal questionnaire was sent to twenty radiotherapy centers in Europe. The questionnaire consisted of two parts. The first part asked for reasons for starting radiotherapy, parameters that influenced the choice of total dose and fractionation and the kind of equipment that was used. The second part presented five case histories asking the responders about the management of these five theoretical patients and regarding the radiotherapy techniques proposed and the aim of treatment. Results: Seventy percent of the centers replied. The responders suggested that the most important factors, which influence the choice of total dose and fractionation schedule, are distant metastases (100%), patients’ performance status (100%), lung function (90%) and size of the primary tumor (81%). Less important factors are gender (8%) and histology (43 %). The most common reasons for starting the treatment is not only symptom relief, but also cure. More than 95 % of the responders replied that they would give radiotherapy in all five cases. The median total doses proposed where 20 Gy/5 fractions/1 week or 30 Gy/10 fractions/2weeks for the cases A and D (equivalent dose for fractionation of 2 Gy per fraction = 23 and 33 Gy) and 60 Gy/30 fractions/6weeks or 68 Gy/34 fractions/7weeks for the cases B, C and E. For the case E, 20% of the responders suggested Stereotactic Body Radiotherapy with 63 Gy in 3 fractions. Conclusions: This survey demonstrates a range of treatment strategies for advanced NSCLC within Europe. Influential factors in this study included the perceived aims of treatment and the estimated prognosis of the patient. Those aiming to extent life would give significantly higher total doses in a larger number of fractions, whereas those aiming to relieve symptoms would give significantly lower total doses. These factors should be taken into account when evaluating the effectiveness of different irradiation. Author Disclosure: I. Chalimou, None; H. Lind, None; P. Mavroidis, None; G. Sakellaropoulos, None; G. Nikiforidis, None; N. Papanikolaou, None; B. Lind, None.
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Toxicity to Esophagus during the Treatment of Stage III Non–small-cell Lung Cancer using Three Dimensional Conformal Radiotherapy Combined with Concurrent Chemotherapy
L. Wang, C. Han, Z. Chi The Fourth Hospital of Hebei Medical University, Shijiazhuang, China Purpose/Objective(s): To investigate the radiation toxicity received by esophagus in the treatment of Stage III non–small cell lung cancer (NSCLC) using three dimensional conformal radiotherapy (3D-CRT) combined with concurrent chemotherapy and obtain relevant factors that were important predictors to complications of esophagus. Materials/Methods: During the period from September 2006 to October 2007, 37 patients with Stage III NSCLC received 3DCRT plus concurrent chemotherapy of navelbine+cisplatin (NP) with prescription of 60 Gy/30fx. Chemotherapy was concurrently conducted, using navelbine at the first and the eighth day with 25mg/m2/day and cisplatin at the second, third and fourth day with 60–80mg/m2, and repeating them from the fifth week (i.e., 28 days per cycle). Univariate, multivariate analysis and ROC were performed to assess the association of radiation esophagitis and correlate factors. The factors in the analysis included: gender, age, the status of weight lose, percentage volume of esophagus receiving . 40 Gy (V40), . 45 Gy (V45), . 50 Gy (V50), . 55 Gy (V55), . 60 Gy (V60), the length of esophagus (total circumference) treated with . 40 Gy (LETT40), . 45 Gy (LETT45), .50 Gy (LETT50), .55 Gy (LETT55), . 60 Gy (LETT60), the maximum dose in the esophagus (Dmax) and the mean dose in the esophagus (Dmean). Results: Of all the patients, 34 (91.89%)developed radiation esophagitis with Grade 1 for 11 patients, Grade 2 for 9 patients and Grade 3 for 14 patients and there was no Grade 4 developed. The correlative factors included Dmean, the LETT40, LETT45, LETT50, LETT55, LETT60, V40, V45, V50, V55 and V60 according to Spearman’ rank correlation analysis. All the above factors could predict radiation esophagitis according to univariate analysis except that V55 was found independently associated with esophagitis according to multivariate analysis. The ROC analysis indicated that the cut-off point of the curve was 30% with the area under ROC curve of 0.906 (p = 0.000), and the corresponding specificity and sensitivity were 100% and 65%, respectively. All the patients with esophageal V55.30% developed 2 or 3 Grade radiation esophagitis in this study, while for the patients with V55#30%, only 8 out of 22 (36.36%) developed severe esophagitis. Conclusions: 3D-CRT combined with concurrent chemotherapy for patients with Stage III NSCLC may develop severe radiation esophagitis. Dosimetric parameters (Dmean, LETT40, LETT45, LETT50, LETT55, LETT60, V40, V45, V50, V55 and V60) were important to radiation esophagitis. According to multivariate analysis, V55 may be the most valuable predictor. When the value of V55 exceeded 30%, the probability of esophagitis may increase notably. Author Disclosure: L. Wang, None; C. Han, None; Z. Chi, None.
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Phase I Study of Pemetrexed, Cisplatin, and Concurrent Radiotherapy in Patients with Locally Advanced Non–small Cell Lung Cancer
B. Li, Y. Yi, Z. Wang, H. Sun, H. Gong, Z. Zhang Shandong Cancer Hospital, Jinan Shandong Prov, China Purpose/Objective(s): The primary objective of the study was to determine the maximum tolerated dose (MTD) and recommended dose (RD) of pemetrexed in combination with cisplatin, and concurrent late course accelerated hyperfractionated (LCAF)
