663 / 1082
S647
ESTRO 36 2017
_______________________________________________________________________________________________
metastases (p-value 0.008). Finally, 86% of patients with
local failure had distant progression versus only 19% in
cases without local failure (p = 0.004).
Conclusion
According to current findings, pre-SABR SUV max and
mean seem to predict early response in lung SABR for
oligometastases.
EP-1207 Outcomes and prognostic factors in solitary
brain metastasis from small cell lung cancer
D. Bernhardt
1
, S. Adeberg
1
, F. Bozorgmehr
2
, J. Kappes
3
,
J. Hoerner-Rieber
1
, L. Koenig
1
, J. Debus
1
, M. Thomas
2
, A.
Unterberg
4
, F. Herth
3
, C.P. Heussel
5
, M. Steins
2
, S.
Rieken
1
1
University Hospital of Heidelberg, Department of
Radiation Oncology, Heidelberg, Germany
2
University Hospital of Heidelberg, Department of
Thoracic Oncology- Thoraxklinik- Translational Lung
Research Centre Heidelberg TLRC-H, Heidelberg,
Germany
3
University Hospital of Heidelberg, Department of
Pneumology- Thoraxklinik, Heidelberg, Germany
4
University Hospital of Heidelberg, Department of
Neurosurgery, Heidelberg, Germany
5
University Hospital of Heidelberg, Diagnostic and
Interventional Radiology with Nuclear Medicine-
Thoraxklinik, Heidelberg, Germany
Purpose or Objective
Whole brain radiation therapy (WBRT) was historically the
standard of care for patients with brain metastases (BM)
from small cell lung cancer (SCLC). Even though, for
patients from other solid tumours, locally ablative
treatments are standard of care for patients with 1-4 BM.
The objective of this analysis was to find prognostic
factors influencing overall survival (OS) and progression-
free survival (nPFS) in SCLC patients with solitary BM (SBM)
treated with WBRT.
Material and Methods
We identified 52 patients in our cancer center database
that had histologically confirmed SCLC and contrast
enhanced magnet resonance imaging (MRI) or computed
tomography (CT) confirmed SBM between 2006 and 2015.
Kaplan–Meier survival analysis was performed for survival
analyses. For comparison of survival curves, Log-rank
(Mantel-Cox) test was used. Univariate Cox proportional-
hazards ratios (HRs) were used to assess the influence of
cofactors on OS and nPFS.
Results
The median OS after WBRT was 5 months and the median
nPFS after WBRT was 16 months. Patients who received
surgery prior to WBRT had a significantly longer median OS
of 19 months compared to 5 months in the group receiving
only WBRT (p=0.03; HR 2.24; 95 % CI 1.06-4.73). Patients
with synchronous disease had a significantly longer OS
compared to patients with metachronous BM (6 months vs.
3 months, p=0.005; HR 0.27; 95 % CI 0.11-0.68). Univariate
analysis for OS did show a statistically significant effect
for metachronous disease (HR 2.84; 95% CI 1.26-6.38;
p=0.012), initial response to first-line chemotherapy (HR
0.54; 95% CI 0.30-0.97; p=0.04) and surgical resection (HR
0.25; 95 % CI 0.07-0.83; p=0.024). NPFS was significantly
affected by metachronous disease in univariate analysis
(HR 14.84; 95% CI 1.46-150.07; p=0.02).
Conclusion
This analysis revealed that surgery followed by WBRT leads
to an improved OS in patients with SBM in SCLC. Further,
synchronous disease and response to initial chemotherapy
appeared to be major prognostic factors. We propose that
locally ablative treatments in combination with WBRT for
SBM in SCLC should be considered for therapy. Surgery
followed by WBRT should be favored in patients with
unknown primary, when pathologic confirmation is
required or in patients with large single brain metastasis
causing mass effect. The value of WBRT, SRS or surgery
alone or the combination for patients with limited number
of BM in SCLC must be evaluated in further prospective
clinical trials.
EP-1208 Concomitant chemoradiotherapy followed by
stereotactic ablative boost in non small cell lung
cancer
J. Doyen
1
, M. Poudenx
2
, J. Gal
3
, J. Otto
2
, J. Mouroux
4
, B.
Padovani
5
, A. Leysalle
1
, C. Guerder
6
, E. Chamorey
3
, P.
Bondiau
1
1
Centre Antoine Lacassagne, Radiation Oncology, Nice,
France
2
Centre Antoine Lacassagne, Medical Oncology, Nice,
France
3
Centre Antoine Lacassagne, Statistics, Nice, France
4
CHU Teaching hospital, Thoracic surgery, Nice, France
5
CHU Teaching hospital, Radiology, Nice, France
6
Hôpital de la Croix Rouge, Radiation Oncology, Toulon,
France
Purpose or Objective
The randomized phase III RTOG 7301 trial failed to
demonstrate a survival advantage by increasing radiation
dose until 74 Gy in locally advanced non small cell lung
cancer
(NSCLC)
treated
by
concomitant
chemoradiotherapy (CRT) and found that mean dose to the
heart correlated independently with overall survival (OS).
By increasing the dose to the tumor with stereotactic
ablative radiotherapy (SABR) one could lead to a greater
dose to the target while decreasing the dose to the heart
and could improve outcome. A phase I trial was conducted
to firstly demonstrate feasibility of this strategy.
Material and Methods
After 2 induction cycles with cisplatinum (75 mg/m²) and
docetaxel (75 mg/m²) CRT used the same regimen (25
mg/m²) in a weekly basis and delivered 46 Gy in 23
sessions; then 3 consecutive fractions of 7 Gy were given
with SABR technique with increasing of 1 Gy per session
for next dose level (6 dose level; dose escalation with
TITE-CRM method). Patients were eligible for the
treatment if target volume after 46 Gy was < 6 cm.
Results
Twenty-six patients (pts) were treated between March
2010 and June 2015; number of pts for dose level 1, 2, 3,
4, 5 and 6 were respectively of 3, 4, 3, 3, 9 and 4. Median
age was of 65.4 years (46-81) with 7 female, 19 male, 1
stage I, 1 stage IIB, 14 stage IIIA, 7 stage IIIB and 3 stage
IV disease (oligometastatic). With a median follow-up of
37.1 months (1.7-60.7), limiting toxicities (grade 3 to 5)
were as follow: G4 oesophagitis (fistula) at dose level 5;
grade 5 (hemoptysis) at dose level 6. Patients mainly
presented with grade 1-2 asthenia (n=12) or alveolitis
(n=9). There were one complete response (3.8%), 17
partial responses (65.4%) and 7 stabilizations (26.9%). The
2-years local control, metastasis-free survival and overall
survival were respectively of 70.3%, 44.5% and 50.8%.
Conclusion
The maximal tolerated dose was 3 X 11 Gy after 46 Gy
(Biological Effective Dose: 115.3 Gy) and could be tested
in a phase II trial.
EP-1209 SBRT for lung metastases: retrospective
analyses of tumor control and toxicity with a lower BED.
Y. Crempe
1
, I.P. barbosa
1
, C.D.O. Rodrigues
1
, E. Gil
1
, P.H.
Zanuncio
1
, P.L. Moraes
1
, l. Fagundes
1
, R. Ferrigno
1
1
hospital beneficencia portuguesa de sao paulo, radiation
oncology, sao paulo, brazil
Purpose or Objective
Many fractionations have been effective on tumor control
of primary lung cancer or metastatic lung lesions, most
with BED
10
> 100Gy
10
. The aim of this series is to test safety
and effectivity of a dose fractionation with a lower BED in
the treatment of lung metastatic disease.
Material and Methods