ESTRO 36 Abstract Book

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S646 ESTRO 36 2017
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3 S.Andrea University Hospital, Radiation Oncology,
Rome, Italy
Purpose or Objective
To evaluate treatment outcomes and patterns of CT lung
injury after hypofractionated image-guided stereotactic
body radiotherapy (SBRT) delivered with helical
tomotherapy (HT) in a series of inoperable lung lesions.
Material and Methods
68 medically inoperable patients (69 lesions) without
evidence of viable extrathoracic disease were included.
Assessment of tumor response was based on the RECIST
1.1 criteria coupled with a 18F-FDG/PET-CT. Toxicity
monitoring was focused on treatment-related pulmonary
adverse events according to the CTCAE v. 4.0. Acute and
late events were classified as radiation pneumonitis (RP)
and radiation fibrosis (RF), respectively. Kaplan-Meier
survival analysis was used to evaluate the progression-free
(PFS) and overall survival (OS).
Results
After a median follow-up of 12 months (range, 3–31
months), no istances of ≥ Grade 4 RP was documented and
clinically severe (Grade 3) RP occurred in 5.8% of the
patients. Two patients (3%) developed a late severe
(≥Grade 3) symptomatic RF. No specific pattern of CT lung
injury was demonstrated, in both acute and late setting.
Median OS and PFS for the entire population were 30.8 and
14.1 months, respectively. At MVA, BED ≥100 and KPS ≥90
emerged as a significant prognostic factors for OS (p = 0.01
and p = 0.001, respectively), and BED ≥100 for PFS (p =
0.02).
Conclusion
Our findings show that a risk adaptive approach of HT-
SBRT based on tumor location is an effective treatment
with a mild toxicity profile in medically inoperable
patients with lung tumors. No specific pattern of lung
injury was demonstrated.
EP-1205 The prognostic role of Neutrophil-to-
lymphocyte ratio in limited disease small-cell lung
cancer
L. Käsmann1, L. Bolm 1, L. Motisi 1, S. Janssen1, S.E.
Schild 2, D. Rades1
1 University of Lübeck, Department of Radiation
Oncology, Lubeck, Germany
2 Mayo Clinic, Department of Radiation Oncology,
Scottsdale- AZ, USA
Purpose or Objective
Small cell lung cancer is an aggressive cancer type of
neuroendocrine origin. Even patients with limited disease
have a poor prognosis of 16-24 months. Standard
treatment of these patients is radiochemotherapy with
cisplatin and etoposide followed by prophylactic cranial
irradiation. Systemic inflammation has been suggested an
important prognostic factor for outcome in several types
of cancer. In this study, we investigated the impact of
systematic inflammation represented by the neutrophil-
to-lymphocyte ratio (NLR) at diagnosis in patients with
limited disease small-cell lung cancer (LD-SCLC) for
outcomes.
Material and Methods
Data of 65 patients receiving radiochemotherapy for LD-
SCLC were analyzed. NLR was obtained from blood
samples at diagnosis. NLR plus 12 factors, namely gender,
age, ECOG performance score, T-category, N-category,
number of pack years, smoking during radiotherapy (RT),
respiratory insufficiency prior to RT, haemoglobin levels
during RT, EQD2 (<56 Gy vs. ≥56 Gy), concurrent
chemotherapy and PCI, were evaluated for local control,
metastases-free survival and overall survival.
Results
The overall survival rates at 12, 24 and 36 months were
71%, 45% and 28%, respectively. Median survival time was
20 months. On univariate analysis of local recurrence,
lower T-stage (1-2 vs. 3-4) was associated with improved
local control at 36 months (62% vs. 41%, p=0.04). On
multivariate analysis, T-stage was an independent factor
(p=0.035; HR 1.84 (95% Cl 1.04-3.86)). Improved
metastases-free-survival on univariate analyses was found
for NLR <4 (p=0.011), ECOG 0-1 (p=0.002), nodal stage N0-
1 (p=0.048), non-smoking during RT (p=0.009), and
administration of PCI (p=0.006). On multivariate analysis,
a trend for improved metastases-free-survival was
observed for NLR <4 (p=0.063; HR 2.19 (95% Cl 0.96-5.06))
and N0-1 (p=0.0623; HR 3.4 (95% Cl 0.95-21.9)). Improved
overall survival rates were found for NLR <4 (p=0.001),
ECOG 0-1 (p<0.001), non-smoking during RT (p=0.007), no
respiratory insufficiency prior to RT (p=0.03) and PCI
(p<0.001). On multivariate analysis, NLR <4 (p=0.03; HR
2.05 (95% Cl 1.06-3.95)), ECOG 0-1 (p=0.002; HR 3.41 (95%
Cl 1.57-7.36)) and PCI (p=0.015; HR 2.56 (95% Cl 1.21-5.34)
were independently associated with improved survival.
Conclusion
In this study, NLR was an independent prognostic factor
for overall survival in patients with LD-SCLC. NLR can help
identify patients with poor prognosis and appears an
useful prognostic marker in clinical practice. A
prospective analysis is warranted to confirm our findings.
EP-1206 FDG-PET/CT predictive parameters of early
response after SABR for lung oligometastases
R. Mazzola1, N. Giaj Levra1, A. Fiorentino1, S. Fersino1, F.
Ricchetti1, U. Tebano1, D. Aiello1, R. Ruggieri1, F. Alongi1
1Sacro Cuore Don Calabria Cancer Care Center, Radiation
Oncology, Negrar-Verona, Italy
Purpose or Objective
To investigate the role of 18FDG-PET/CT parameters as
predictive of early response after Stereotactic Ablative
Radiation Therapy (SABR) for oligometastases lung lesions.
Material and Methods
SABR for lung oligometastases was performed when the
following criteria were satisfied: a) controlled primary
tumor, b) absence of progressive disease longer than 6
months, c) number of metastatic lesions ≤ 5. The
prescribed total dose varied according to the risk-adapted
dose prescription with a range of doses between 48-70 Gy
in 3-10 fractions. Inclusion criteria of the current
retrospective study were: a) lung oligometastases
underwent to SABR, b) for each patient presence of 18-
FDG-PET/CT pre- and post-SABR for at least two
subsequent evaluations, c) Karnofsky performance status
> 80, d) life-expectancy > 6 months.
The following metabolic parameters were defined semi-
quantitatively for each lung lesion: 1) SUV-max, 2) SUV-
mean, 3) Metabolic Tumor Volume (MTV), 4) Total Lesional
Glycolysis (TLG).
Results
From January 2012 to November 2015 fifty patients for a
total of seventy lung metastatic lesions met the inclusion
criteria of the present analysis. Pre-SABR, median SUV-
max was 6.5 (range, 4 - 17), median SUV-mean was 3.7
(2.5 - 6.5), median MTV was 2.3 cc (0.2 - 31 cc). For
patients with in-field disease progression median TLG was
17.4 (2 - 52.8), for the remaining the median value was
170.6 (0.5 - 171). For pre-SABR SUV-max ≥ 5 a
progression/stable metastasis was noted in 88% of cases,
while a complete response was observed in 94% of cases
for pre-SABR SUV-max < 5 (p < 0.001, Sensitivity = 88%,
Specificity = 94%). A pre-SABR SUV-mean < 3.5 was related
to complete response at 6 months after SABR (p 0.03,
Sensitivity = 31%, Specificity = 34%, AUC = 0.32). In cases
of in-field failure, a pre-SABR SUV-max > 8 was related to
a higher absolute value increase of SUV-max at 6 months
of follow up comparing to pre-SABR SUV-max < 8 (p 0.005).
Delta SUV max 3-6 months was +126% for lesions with in-
field progression versus -26% for the remaining (p-value
0.002). Delta SUV-mean 3-6 months was +15% for lesions
with in-field progression versus for the remaining