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ESTRO 36 2017
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Retrospective analyses of 46 patients with metastatic
tumor to the lungs treated with SBRT with dose of 40 Gy
in 4 fractions (BED
10
= 80Gy
10
), twice a week, from January
2013 to October 2016. The minimal time of follow-up was
six months to analyse local control, acute and late
toxicity. The most frequent primary site was
gastrointestinal (GI) with 15 patients (32,6%), followed by
soft tissue neoplasm with 8 patients (17,3 %),
genitourinary (6 patients) and melanoma (6 patients).
Results
With a median follow-up of 16 months (range 6 to 40
months), the recurrence free survival was 93,2% in 12
months and 88,4% at the time of this analyses. Three
patients developed local failure, after 14, 15 and 16
months of treatment. Five patients (10,8 %) had
symptoms, including grade III pneumonitis (4 patients),
toracic pain (1 patient) and arm paresthesia (1 patient),
with a median time of 8,6 months from the end of the
therapy, but only one did not have completely remission
of symptoms in 30 days after the beginning, evolving with
pathologic rib fracture that got better after four months.
Conclusion
This series suggests that SBRT with dose of 40 Gy in 4
fractions (BED
10
= 80Gy
10
) twice a week, is safe and
effective for metastatic lung lesions and can be
considered for prospective clinical trials to be tested as a
reasonable option of dose fractionation.
EP-1210 SBRT with FFF Beams and V-MAT for lung
cancer. A mono-institutional experience.
F. Martucci
1
, P. Fanti
1
, B. Muoio
1
, S. Cima
1
, C. Azinwi
1
, K.
Yordanov
1
, G. Pesce
1
, M.C. Valli
1
, S. Presilla
2
, A. Richetti
1
1
Istituto Oncologico della Svizzera Italiana, Radiation
Oncology, Bellinzona, Switzerland
2
Ente Ospedaliero Cantonale, Medical Physics Service,
Bellinzona, Switzerland
Purpose or Objective
Stereotactic body radiotherapy (SBRT) is a method of
external beam radiotherapy that accurately delivers a
high irradiation dose to an extracranial target in one or
few treatment fractions. Based on current evidence, SBRT
is a valid and curative treatment for unresectable lung
nodules. Aim of this study is to evaluate the efficacy and
toxicity of SBRT in pts with early lung cancer and
metastatic pulmonary lesions.
Material and Methods
We retrospectively analysed data of 41 consecutive pts
with lung nodules treated in our centre from September
2011 to December 2015. Demographic patient data and
dosimetric data regarding SBRT treatments were
collected. Acute toxicity (defined as toxicity < 45 days)
and late toxicity (defined as toxicity > = 45 days) were
reported and graded as per standardized CTCAE 4.0
criteria. Progression free survival (PFS) and overall
survival (OS) were also described.
Results
The median age was 71 years (range 52-90). Twenty pts
were diagnosed with primary or recurrent lung cancer, 21
pts had metastatic lung nodules of varying histologies.
Thirty pts had an histologically proven diagnosis, while the
remainder were treated after multidisciplinary decision in
the face of suspicious PET/CT imaging. The median follow
up was 29 months (range 3-56). The treatment was
delivered with a Biologically Effective Dose (BED10) ≥ 90
GyE, in 3 to 6 fractions, with volumetric modulated arcs
with flattening filter free beams. The median Planning
Target Volume (PTV) was 13.1 cm
3
(range 4.6-70). OS at 1
and 2 years was 91.8% and 85.7%, respectively. PFS at 1
and 2 years was 91.7% and 81.5%, respectively. No
statistical significative difference in terms of OS e PFS was
found between primary and metastatic lesions setting (p=.
0.098 and p=0.520). Nine of 41 pts had a relapse, and
among them only 1 patient showed a recurrence inside the
irradiated field. No acute toxicities were registered. Late
toxicity was recorded in 2 pts: a grade 2 pneumonitis and
a grade 1 rib fracture.
Conclusion
SBRT delivered using linac-based flattening filter free
volumetric modulated arc radiotherapy is feasible and
well tolerated. Our experience confirm excellent long-
term local control rates and a very low rate of late
toxicity.
EP-1211 How selected are patients in clinical trials of
radiotherapy for non-small cell lung cancer?
M. Berry
1,2
, K. Neville
1
, J. Ruben
3,4
, L. Holloway
1,2,5,6,7
, S.
Vinod
1,2,8
1
Liverpool Cancer Therapy Centre, Radiation Oncology,
Sydney, Australia
2
South Western Sydney Clinical School, University of New
South Wales, Sydney, Australia
3
William Buckland Radiotherapy Centre, The Alfred
Hospital, Melbourne, Australia
4
Monash University, Melbourne, Victoria, Australia
5
Ingham Institute of Applied Medical Research, Medical
Physics, Sydney, Australia
6
Centre for Medical Radiation Physics, University of
Wollongong, Wollongong, Australia
7
Institute of Medical Physics- School of Physics,
University of New South Wales, Sydney, Australia
8
Western Sydney University, Sydney, New South Wales,
Australia
Purpose or Objective
Clinical practice guidelines based on evidence derived
from clinical trials are used to guide management of
patients with non-small cell lung cancer (NSCLC). However
patients enrolled in trials must fulfil various eligibility
criteria, and may not represent the wider patient
population.
The aim of this study was to review eligibility criteria of
clinical trials performed in patients with NSCLC and
compare the characteristics of an Australian clinical
patient cohort against these criteria.
Material and Methods
A systematic Medline & Embase search was conducted to
identify all randomized clinical trials published in English
from 2005-2014 concerning curative radiotherapy for
Stage I-III NSCLC. Trials on stereotactic ablative
radiotherapy, brachytherapy, post-operative radiotherapy
or adjuvant therapy were excluded. Eligibility criteria for
entry into these trials were evaluated. A database of
contemporaneous NSCLC patients from the Liverpool and
Macarthur Cancer Therapy Centres in Sydney, Australia,
and from the William Buckland Radiotherapy Centre at the
Alfred Hospital in Melbourne, Australia, was reviewed.
Results
Twenty-two trials were identified. Performance status
was a defined eligibility criterion in all trials, with twelve
trials limiting this to ECOG 0-1 and ten to ECOG 0-2.
Seventeen trials specified eligibility by age, with five
excluding patients >70-80 years. Weight loss was specified
in nine trials, being ≤5% in three trials, and ≤10% in six
trials. Eight trials excluded patients with cardiac co-
morbidity. All trials included use of chemotherapy, so
blood test parameters were used for inclusion. Twelve
trials had minimum pulmonary function/blood
oxygenation requirements for entry. Fourteen trials
excluded patients with a history of previous cancer in the
past three years.
There were 366 patients treated with curative
radiotherapy for NSCLC in the featured cancer centres
from 2005-2014. Clinical trial eligibility criteria were not
met in 66 patients (18%) because of performance status,
and in 60 (16%) because of weight loss. 162 (44%) would
have been excluded because of cardiac co-morbidity, and
41 (11%) would have been excluded because of prior
cancer.