ESTRO 36 Abstract Book

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S653 ESTRO 36 2017
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After a median interval of 11.5 months, 17 patients (31%)
relapsed locally or regionally: six within the initial primary
tumour volume, five within the initially affected lymph
nodes, three metachronously within primary tumour and
initially affected lymph nodes, and three both inside and
outside of the initial nodal disease. All sites of loco-
regional recurrence had received 92%-106% of the
prescribed dose. Thirty-seven patients (69%) developed
distant metastases (37.8% liver, 35% brain). Among all
investigated co-factors only total GTV revealed a
significant correlation with patient outcome.
Conclusion
In our study most recurrences occurred in the initial
primary tumour or lymph node volume, or distantly. We
did not register any case of isolated nodal failure,
suggesting the use of selective nodal irradiation, possibly
with the addition of supraclavicular irradiation in patients
with affected lymph nodes in the upper mediastinum,
instead of ENI.
Among all investigated patient- and tumour-related co-
factors only total GTV revealed a significant correlation
with patient outcome. Further prospective clinical trials
are needed for final determination of optimal irradiation
fields in SCLC patients.
EP-1221 Adherence to lung cancer guidelines and its
impact on survival
I. Linares1, M. Sánchez2, J. Pérez-Alija3, E. Molina2, Y.
Chang-Chan4, R. Guerrero5, J. Expósito5
1 Institut català d´Oncologia ICO- L'Hospitalet de
Llobregat, Radiation Oncology, Barcelona, Spain
2 Escuela Andaluza de Salud Pública. Instituto de
Investigación Biosanitaria ibs. Hospitales Universitarios
de Granada/Universidad de Granada CIBER de
Epidemiología y Salud Pública CIBERESP, Escuela
Andaluza de Salud Pública, Granada, Spain
3 Hospital Plató, Radiation Oncology, Barcelona, Spain
4 Escuela Andaluza de Salud Pública. Instituto de
Investigación Biosanitaria ibs. GRANADA. Hospitales
Universitarios de Granada/Universidad de Granada,
Escuela Andaluza de Salud Pública, Granada, Spain
5 Complejo Hospitalario Universitario de Granada,
Radiation Oncology, Granada, Spain
Purpose or Objective
Clinical practice guidelines are tools to improve quality
and reduce variability of cancer care. Our objective is to
evaluate the concordance between lung cancer guidelines
and clinical practice in Granada and its impact on
survival.
Material and Methods
Data were obtained from the population-based cancer
registry in Granada (Spain). All cases of newly diagnosed
primary lung cancer (non-small-cell lung cancer a small
cell lung cancer) in 2011-2012 were included. To describe
the adherence to guidelines, 10 indicators regarding
diagnostic and treatment were identified. The indicators
were assigned according to the pathology, stage and ECOG
performance status. For those patients who did not adhere
to the indicators, the medical record was reviewed to
determine the reason for this. One and two-year relative
survival was compared between patients treated
according to clinical guide recommendations and those
who were treated otherwise.
Results
685 patients were enrolled; 490 were discussed at a
multidisciplinary team meeting. Microscopic verification
was available in 81%. 58.6% did not received guideline
recommended diagnosis and treatment. Most common
non-adherence reasons were a bad performance status
and advanced age (16.3%), exitus (8.8%) and patient
preference (2.8%). Better adherence was shown in early
stage (62.1% stage I and 66.7% stage II versus 57% stage IV)
and women (68.3% versus 44.8% in men). Patients who
received guideline recommended diagnosis and treatment
had improved survival compared with those who did not:
one and two-year relative survival of 51% and 28.2% versus
34.1% and 17.5%.
Conclusion
Guidelines adherence monitoring can be useful to reduce
variability in cancer care. A significant proportion of cases
of non-adherence to guidelines are due to unavoidable
causes. Alternative guidelines are needed for those cases.
Acting in accordance to guidelines improves survival.
EP-1222 Beclin-1 expression of circulating tumor cells
in non-small cell lung cancer patients.
C. Prieto Prieto1, D. De Miguel2
1Hospital Universitario Virgen de las Nieves, Radiation
Oncology, Granada, Spain
2GENYO. Centre for Genomics and Oncological Research,
Pfizer/University of Granada/Andalusian Regional
Government-, Granada, Spain
Purpose or Objective
Non-small cell lung cancer (NSCLC) accounts for 75-80% of
the total lung cancer cases, including those at advanced
stages IIIA and IIIB, where chemotherapy and radiotherapy
are the main recommended treatments. Despite this,
recurrence and progression are still present, largely
caused by the release of circulating tumor cells (CTCs) into
peripheral blood, where they travel up to a secondary
organ to establish metastasis. Autophagy is an auto-
proteolitic mechanism by which eukaryotic cells can
surround intracellular components into vesicles like
lysosomes. Beclin-1, whose expression has never been
described in CTCs, is plays a critical role in the regulation
of autophagy. In spite of this, its role as a risk factor for
radiotherapy resistant is not clear yet. Our objective was
to identify the prognostic value of the presence of CTCs,
from peripheral blood of NSCLC patients undergoing
concomitant radiotherapy and chemotherapy treatment,
and their characterization with Beclin-1.
Material and Methods
This prospective and ongoing study included 21 NSCLC
patients from Virgen de las Nieves Hospital (Granada,
Spain), who have a locally advanced and unresectable
disease (stages: inoperable IIIA, IIIB and IV) and were
treated with concomitant radiotherapy (total dose of 60Gy
with standard fractionation) and chemotherapy (Cisplatin-
Vinorelbine mostly). Follow-up was performed by
computed tomography (CT) for 3 months after the
treatment, however Positron Emission Tomography (PET)
was performed in some of them. According to our
immunomagnetic selection methodology, CTCs were
isolated by epithelial markers from peripheral blood
samples before the treatment, and 3, 8 and 48 weeks after
and characterized for Beclin-1 expression by
immunofluorescence.
Results
Even though the low number of patients, our results
revealed a tendency or an association between presence
of CTCs at baseline status with; tumor response observed
by CT and PET (p=0.99), tumor stage (p=0.036) and local
and distant progression (p=0.088). On the other hand, 19%
of the patients showed CTCsBECLIN1+ but it was not
associated with any clinicopathological variables as
progression or mortality.
Conclusion
In conclusion, the presence of CTCs before treatment may
be a predictive factor for progression in NSCLC patients,
but Beclin-1 may not, however more patients are needed
to reach statistical significance.
EP-1223 Comparing concurrent versus sequential
chemoradiotherapy in locally advanced NSCLC
G. Wei1, G. Xiaobin1, G. Xian-Shu1, M. Mingwei1, C. Ming1,
P. Chuan 1
1Peking University First Hospital, Department of
Radiation Oncology, Beijing, China