ESTRO 36 Abstract Book

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S664 ESTRO 36
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Purpose or Objective
There is no consensus on the application of PORT in
patients with completely resected NSCLC and
histologically confirmed mediastinal lymph node
involvement. In different institutions, the same patients
may be advised to recieve PORT or not, e.g. depending on
the proportion of involved or resected lymph nodes or on
the age and general health of a patient. Therefore our
institution takes part in the randomized LUNG ART study
(NCT00410683) since 2013. The objective of the presented
work was the evaluation of patients consecutively
scheduled for PORT in our institution before our
participation in LUNG ART.
Material and Methods
All distant metastases free patients scheduled for PORT
after resection of a NSCLC between 2008 and 02/2013
were included in a retrospective analysis. Data on
outcome (survival, toxicity) were collected until 07/16.
Results
58 patients (28% female, 72% male), median 67 years, with
a NSCLC (50% SCC, 45% adenocarcinoma and 5% other) and
pretherapeutic UICC-stage IIa (2%), IIb (3%), IIIa (93%) und
IIIb (2%) were evaluated. The postoperative nodal status
was N2 in 50 (86%) patients and N1 and N0 in 4 patients
(7%), respectively. Median 2,5 (0-7) lymph nodes stations
were histologically involved. 25 (42%) patients recieved
neoadjuvant platinum-based chemotherapy, a
downstaging of tumor or lymph nodes could thereby be
achieved in 44% and 5% of these patients. 19 (32%) patients
recieved adjuvant chemotherapy. Resection mostly was
performed by lobectomy (74%), less common were
pneumectomy (12%), sleeve resection (7%), others (7%). In
90% of patients resection was complete, 10% had
microscopically involved margins.The median duration
between resection and start of PORT were 51 (23-212)
days. PORT was applied in 95% of patients by means of 3D-
conformal planning, in 5% with IMRT. Median duration of
PORT were 39,5 (16-51) days with a median total dose of
52,6 (45-60) Gy. 22% of the patients had a locoregional
progression median 7 (2-52) months after PORT, of these
54% within the irradiated area which had recieved median
50 (45- 59,4) Gy. 62% of patients developed distant
metastases median 15,5 (0-88) months after PORT. 75% of
patients died, most due to tumor progression (62%).
Median actuarial overall survival was 32 (1-88) months,
median progression free survival 11 (1-53) months. The
evaluation of risk factors for survival and of toxicity data
is ongoing.
Conclusion
These preliminary data show that a fifth of patients after
PORT will develop a locoregional recurrence, which
complys with data in the literature, and imply that doses
of around 50 Gy may not be sufficient to prevent
locoregional recurrence in these patients.
EP-1231 Early Clinical outcome of the first lung SBRT
program in a developing country
S. Wadi-Ramahi1, J. Khader 2, F. Abu Hijli2, H.
Ghatasheh2, A. Sulaiman2
1 King Faisal Specialist Hospital and Research Center,
Biomedical Physics, RIyadh, Saudi Arabia
2 King Hussein Cancer Center, Radiation Oncology,
Amman, Jordan
Purpose or Objective
The stereotactic body radiation therapy (SBRT) program at
our institution was established through cooperation with
an internationally renowned institution and it went
clinical in 2012. Until the present day, it stands as the only
SBRT program in the entire country with patient
population that has increased dramatically in the past few
years due influx of refugees from regional conflicts. Here,
we will present the early clinical outcome of patients
treated for lung tumors with SBRT.
Material and Methods
10 patients were treated to date in the SBRT service. All
patients underwent 10-phase 4DCT and PET-CT scans. The
internal target volume (ITV) was constructed from the
minimum intensity projection (MIP) dataset and
expanded, if needed, following PET findings. 5mm margin
was added to create the PTV. All patients received a dose
scheme of 48Gy/4 fractions except for 2 who received
60Gy/8 fractions due to toxicity concerns. Lung
heterogeneity correction was used during planning on
Pinnacle3 (Philips, Netherlands) and treatment delivery
was done on Precise linacs (Elekta, Sweden). Positioning
was done by using CBCT imaging on every fraction. After
completion of SBRT the patient is seen in 2 weeks for
clinical evaluation and follow up (FU) for possible acute
side effects. The FU is both clinical and radiological with
alternating CT Chest and PET/CT scans every 3-4 months
for the first 2 years and 6 months interval afterwards.
Results
All patients treated were males, with age ranging from 50-
84 years old, mode of 79. All patients were unfit for
surgery except for one who refused surgery. Table 1
summarizes the patients’ data showing histology, tumor
size, location, and status after last FU. Eight out of ten
patients have shown either regression or no evidence of
disease (NED) since last FU, while 2/10 have stable
disease. One death occurred 15 months from treatment
due to unrelated causes, the patient was NED in his last
FU. The longest FU period so is 54 months for the first
patient treated.
Conclusion
The newly established SBRT clinical service in our country
serves as the only such treatment for inoperable lung
tumor for a population of about 10 million, including 2.7
million refugees. We have started recruiting inoperable
lung patients to the service at a slow pace to gain more
confidence and experience before admitting larger
numbers. One of the major unforeseeable difficulties was
the long term follow up, this is partly a result of
heterogeneity in patient population. Albeit the short FU,
early clinical results are encouraging with most treated
patients showing tumor regression or NED.
EP-1232 Patient-reported toxicity in twice-daily (BID)
versus once-daily (OD) chemoradiotherapy for LS-SCLC
J. Lodeweges1, A. Niezink1, H. Elzinga1, E. Haan-
Stijntjes1, N. Dollekamp1, O. Chouvalova 1, J. Ubbels1, M.
Woltman-van Iersel1, A. Van der Leest1, J. Langendijk1, J.