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ESTRO 36
_______________________________________________________________________________________________
2
Greater Poland Cancer Centre, Greater Poland Cancer
Register, Poznan, Poland
Purpose or Objective
In 2013 1.963 (ASR 33,6/10
5
) new lung cancer cases and
1.855 (ASR 31,1/10
5
) lung cancer deaths were reported in
Greater Poland. Compared to 1999 the number of new
cases rose by 21% and the number of deaths rose by 16%.
In the group of lung cancer patients from the Greater
Poland population, diagnosed during 2009-2011, 80% were
microscopically verified, among them 79,9% were NSCLC
and 20,1% were SCLC. Prophylactic Cranial Irradiation
(PCI) in SCLC patients remains an important part of the
treatment process associated with a reduction of brain
metastases and better survival. This paper is a
retrospective review of 146 patients irradiated in Greater
Poland Cancer Center, Poznan, Poland.
Material and Methods
Eighty limited SCLC (LSCLC) and sixty six extensive SCLC
(ESCLC) patients irradiated in Greater Poland Cancer
Center between 2007-2010 received a standard scheme of
25Gy/10fx with 6MV photons. The qualification based on
X-ray post-chemotherapy assessment described as
significant partial response or complete response. Mean
time from the diagnosis date to the end of treatment was
6 months. The survival data were collected from the
national and regional cancer registers.
Results
Mean observed survival in our patients was 16,8 months
(13,6 months for ESCLC and 19,5 months for LSCLC). The
1-, 3- and 5-year observed survival rates were 74,12%,
9,52%, 4,70% for LSCLC and 48,48%, 1,49% 1,49% for ESCLC.
For our group as a whole respectively: 65%, 8,6%, 3,3%.
After radiotherapy, LSCLC and ESLCL patients survived 7,4
and 12,7 months on average. Grade 3 or 4 toxicity has not
been noticed.
Conclusion
The Concord-2 study results show, that the 5-year net
survival rates among lung cancer patients diagnosed
during 2005-2009 in Poland (13,4%) and Greater Poland
(13,2%) were on the average European level. Similarly,
presented SCLC group meets 5-year survival rates of that
time. Comparing to other authors, we have noticed
slightly better results in 1- year survival - Schild et al: 56%
(PCI arm, LSCLC&ESCLC), Slotman et. al: 27,1% (PCI arm,
ESCLC).
Nevertheless, in spite of good results shown above, the
prospective analysis shoud be done. Contemporary salvage
treatments for intracranial relapse may be
underestimated especially if provided before patients
become symptomatic.
EP-1235 Stereotactic body radiotherapy for lung
metastases: retrospective analysis of a single-center
H. Herrmann
1
, C. Proksch
1
, K. Dieckmann
1
1
Universitätsklinik für Strahlentherapie Medizinische
Universität Wien, Wien, Austria
Purpose or Objective
A significant number of cancer patients with initially
localized disease develop distant metastases at follow up.
A subset of patients with successful treatment of the
primary tumor develop oligometastatic disease months to
years after initial treatment. Other patients with
metastatic disease present with long-lasting stable disease
or remission during systemic treatment and develop
progression in single lesions in later course of disease. For
these patients with low tumor burden, a semi-curative
treatment strategy might be an option. In recent years,
stereotactic body radiotherapy (SBRT) of the lung has
been shown to provide an alternative to surgical resection
of lung metastases. Typically, SBRT in the lung is
performed with high single-doses per fraction. High
radiation doses to the lung could result in severe fibrosis,
which might especially be relevant for patients with
impaired lung function.
Material and Methods
We retrospectively analyzed 95 metastatic patients (male,
n=64; female, n=31) who underwent SBRT in the lung at
our institution from 2005-2015 with a total of 166 lung
metastases. The median age was 65 years (range 38-84
years) at initial SBRT treatment. Primary tumors were
colorectal cancer (n=35), renal cell carcinoma (n=15),
head and neck cancer (n=12), melanoma (n=8), and other
malignancies (n=25). Parameters assessed were: local
control, survival, lung function test before start
of treatment and during follow up, PTV volume, extent of
fibrosis on CT scans.
Results
The treatment regimen most often used was 12.5 Gy x 3
fractions prescribed to the 65% isodose (n=100; EQD2 for
α/β=10 Gy: 70.3 Gy at prescribed isodose, 140.5 Gy at
100% isodose) and 15 Gy x 3 fractions prescribed to the
65% isodose (n=33; EQD2 for α/β=10 Gy: 93.8 Gy at
prescribed isodose, 190.8 Gy at 100% isodose). The median
PTV volume was 15.9 ccm (range: 3.6 – 404.5 ccm). Median
follow up was 20 months (range 1 – 136 months).
The overall survival at 1 and 2 years was 85% and 68%,
respectively. We achieved high local control after SBRT
treatment at 1 and 2 years which was 95% and 88%,
respectively.
Signs of morphologically dense radiation induced fibrotic
changes (hounsfield units > 10 as evaluated on CT scans)
4-6 months after treatment was seen in 40 % of all treated
lesions. The median diameter of these fibrotic changes
were 6.0 cm (range: 2.0 – 10.4 cm). Before SBRT treatment
the median baseline FEV1 value of lung function test was
2.5 L (range: 0.96 – 3.96 L). FEV1 values at 1 years after
treatment (expressed as mean percentage of baseline
FEV1 ±SD) decreased to 95% (±8%) which was significant
(
p
<0.05) in a paired t-test.
Conclusion
SBRT treatment for lung metastases results in high local
control rates and can be safely applied. The impact on
lung function test at one year after treatment was minimal
although high biological doses were delivered. We
conclude, that SBRT to the lung can be recommended to
oligometastatic patients as an effective alternative
treatment to surgical resection.
EP-1236 Validation of the clinical diagnostic method
for solitary pulmonary nodules before SBRT in Navarra
M. Campo
1
, I. Visus
1
, S. Flamarique
1
, M. Barrado
1
, A.
Martin
1
, M. Rico
1
, E. Martinez
1
1
Hospital of Navarra, Oncología radioterapia, Pamplona,
Spain
Purpose or Objective
In the general practice of the Hospital of Navarra, solitary
pulmonary nodules (SPN) are frequently treated with SBRT
without cytological confirmation due to patients´ co-
morbidities that heighten the risks associated with
transthoracic
biopsy.
In this analysis we study the reliability of our clinical
diagnostic system to better know the accuracy and quality
of our protocols.
Material and Methods
We analyze retrospectively the pathological results of SPN
treated surgically under suspicion of being stage I non-
small-cell lung cancer (NSCLC) during 2012 and 2013. The
suspicion was based on the criteria of an expert board
composed by pneumologists, radiation oncologists,
medical oncologists, thoracic surgeons, radiologists and
pathologists. The decision of treating was taken according
to the FDG-PET features, the morphological
characteristics on CT and the growing pattern of the SPN.