Conflict of Interest Declaration: Nothing to Disclose

Presenter: Sophie Lamoureux

Title of Presentation: A Comparison of Stereotactic Body Radiotherapy with Hypofractionated Radiotherapy for Early Stage Non-small Cell Lung Cancer: Control Rates from a Regional Cancer Centre

I have no financial or personal relationships to disclose

Technologies:

- Four Dimensional CT Simulation

- Integrated PET planning

- Conformal Radiation Therapy

- On board Cone Beam CT

45 pts

NECC SABR

- 48Gy in 4 fractions

- VMAT Planning

- SABR Tumor Board

- Patient Selection

• Medically inoperable

• T1 or T2 <5cm

• Biopsy proven or suspected NSCLCa

NECC SABR Database

Baseline demographics

• T Stage

• Size

• Biopsy results

• PET results

• PFT

• Dosimetry

NECC SABR Database

Follow up data – q3mos initially

• Performance Status

• Survival / Cause of death

• Lesional control

• Regional control

• Distant control

NECC SABR Database

Follow up data – CTCAE 4.02

• Chest wall pain

• Esophagitis

• Pneumonitis

• Pulmonary Hemorrhage

Patients

- 54 Patients were treated with 4800/12

- 26 Patients were treated with 5200/13

- 28 Patients were treated with 6000/15

- 76 Patients were treated with SABR of which 33 were peripheral lesions treated with 4800/4

Central lesions treated with 6000/8 were not analysed. Metastatic lesions are not included in this analysis.

Hypofractionation Toxicity

No Data collected

SABR Toxicity

Symptomatic Pneumonitis 0

Pulmonary Hemmorhage 0

Symptomatic Chest Wall Pain 1

Symptomatic Esophagitis 0

33 evaluable patients, Median follow up 245 Days

NECC Hypofractionated DemographicsTable 1. Demographics of early stage lung cancer patients treated with

hypofractionated RT at the NECC

Characteristic Value

No. of patients 108

Median age (in years) 80 (56-99)

Status  

  Alive 43.5%

  Deceased 56.5%

Gender  

  Female 40.7%

  Male 59.3%

Median diameter (in cm) 2.95 (1.0-7.3)

Dose (in cGy)/fraction  

  4800/12 50.0%

  5200/13 24.1%

  6000/15 25.9%

PET Scan  

  Yes 46.1%

  No 53.9%

Bone Scan  

  Yes 63.7%  No 36.3%CT Head  

  Yes 63.7%

  No 36.3%

MRI Head  

  Yes 6.9%

  No 93.1%

Overall Survival (Hypofraction)

0.0

00

.25

0.5

00

.75

1.0

0

0 500 1000 1500 2000 2500analysis time

F M

Kaplan-Meier survival estimates

(days)

Lesional Control (Hypofraction)

0.0

00

.25

0.5

00

.75

1.0

0

0 500 1000 1500 2000 2500analysis time

F M

Kaplan-Meier survival estimates

(days)

0.0

00

.25

0.5

00

.75

1.0

0

0 500 1000 1500 2000 2500analysis time

F M

Kaplan-Meier survival estimates

(days)

Regional Disease (Hypofraction)

Metastatic Disease (Hypofraction)

0.0

00

.25

0.5

00

.75

1.0

0

0 500 1000 1500 2000 2500analysis time

F M

Kaplan-Meier survival estimates

(days)

Regional Disease (Hypofraction)

0.0

00

.25

0.5

00

.75

1.0

0

0 500 1000 1500 2000 2500analysis time

4800/12 5200/136000/15

Kaplan-Meier survival estimates

(days)

Metastatic Disease (Hypofraction)

0.0

00

.25

0.5

00

.75

1.0

0

0 500 1000 1500 2000 2500analysis time

4800/12 5200/136000/15

Kaplan-Meier survival estimates

(days)

Overall Survival0

.00

0.2

50

.50

0.7

51

.00

0 500 1000 1500 2000 2500analysis time

4800/12 4800/45200/13 6000/15

Kaplan-Meier survival estimates

Pr>chi2 = 0.1961 chi2(3) = 4.69

Total 65 65.00 6000/15 6 9.335200/13 13 16.734800/4 4 5.204800/12 42 33.74 Treatmentr~d observed expected Events Events

Log-rank test for equality of survivor functions

(days)

Lesional Control0

.00

0.2

50

.50

0.7

51

.00

0 500 1000 1500 2000 2500analysis time

4800/12 4800/45200/13 6000/15

Kaplan-Meier survival estimates

Pr>chi2 = 0.2314 chi2(3) = 4.29

Total 26 26.00 6000/15 3 5.145200/13 5 7.074800/4 2 2.924800/12 16 10.87 Treatmentr~d observed expected Events Events

Log-rank test for equality of survivor functions

(days)

Conclusion

Radiotherapy for early stage lung cancer has advanced significantly at NECC.

As of Feb 2015, over 76 SABR treatments have been delivered and 108 hypofractionated radiotherapy treatments.

There is a non-significant trend towards improved lesional control with higher doses of RT with no change in regional control, development of metastatic disease, survival or toxicity.