A. Botticella

Prophylactic cranial irradiation or no prophylactic cranial irradiation in metastatic small cell lung cancer: is it a relevant question once again?

Even if chemotherapy is the cornerstone treatment of small cell lung cancer (SCLC), this disease has a particular propensity to recur locally and disseminate in the brain. Hence, there have been several randomized trials assessing the role of thoracic and brain radiotherapy (1). Two individual patient data-based meta-analyses showed that thoracic radiotherapy and prophylactic cranial irradiation (PCI) should be part of the therapeutic strategy (2,3).

Neutrophilia as prognostic biomarker in locally advanced stage III lung cancer

Objective To study the prognostic value of baseline leukocytosis or neutrophiliain two retrospective cohorts of stage III Non-Small Cell Lung Cancer (NSCLC) patients. Materials and methods Clinical records of consecutive previously untreated NSCLC patients in our Institution between June 2001 and September 2016 for stage III NSCLC were collected. The prognostic value of pretreatment leucocyte disorders was examined, with focus on patterns of relapse and survival. Leukocytosis and neutrophilia were defined as a leukocyte count or a neutrophil count exceeding 10 and 7 G/L, respectively. Results We identified 238 patients, displaying baseline leukocytosis or neutrophilia in 39% and 40% respectively. Most were diagnosed with adenocarcinoma (48%), and stage IIIB NSCLC (58%). 3-year actuarial overall survival (OS) and progression-free survival (PFS) were 35% and 27% respectively. Local relapses were reported in 100 patients (42%), and distant metastases in 132 patients (55%). In multivariate analysis, leukocytosis, neutrophilia, and induction chemotherapy regimen based on carboplatin/paclitaxel were associated with worse OS and PFS (p<0.05). Neutrophilia independently decreased Locoregional Control (LRC) (HR = 2.5, p<0.001) and Distant Metastasis Control (DMC) (HR = 2.1, p<0.001). Neutrophilia was significantly associated with worse brain metastasis control (p = 0.004), mostly in adenocarcinoma patients (p<0.001). Conclusion In stage III NSCLC patients, treated with concurrent cisplatin-based chemoradiation, baseline leukocytosis and neutrophilia were associated with worse OS, PFS, LRC, and DMC. In addition with previously available markers, this independent cost-effective biomarker could help to stratify stage III NSCLC population with more accuracy.

Non-small cell lung cancer brain metastases and the immune system: From brain metastases development to treatment

Brain metastases (BM) are diagnosed frequently in non-small cell lung cancer (NSCLC) patients. Despite the high incidence of BM (up to 40% in unselected patients), patients with untreated and/or unstable BM were excluded from pivotal immune checkpoint inhibitors (ICI) NSCLC trials. Percentage of patients with stable and treated BM in these trials ranged from 9.1 to 14.7% and ICI benefit over chemotherapy was not always demonstrated. Only small trials have been completed that demonstrated ICI efficacy in locally untreated, selected BM patients. With 33%, cranial objective response rate (ORR) was comparable to extracranial ORR and responses were often durable. With the promising survival benefits of ICI, in daily practice also unstable and/or untreated BM patients will often receive treatment with ICI and extrapolating clinical trial data to these patients can be challenging. In this review, we will summarize the preclinical rationale and potential concerns for the use of ICI in BM patients. Furthermore, we will summarize BM subgroup data from the pivotal NSCLC trials, retrospective series, the NSCLC BM specific ICI trials and the use of cranial radiation and ICI. Last, we provide an overview of response measurement criteria and future directions.

Radiothérapie des cancers bronchiques à petites cellules

Resume Les cancers bronchiques a petites cellules (CBPC) representent environ 13 % des cancers bronchiques. Avec une incidence en baisse ces vingt dernieres annees, le CBPC reste un cancer au pronostic particulierement sombre du fait notamment d’un temps de doublement court qui explique la presentation metastatique dans pres de deux tiers des cas au diagnostic. Si la chimiotherapie reste la pierre angulaire du traitement des CBPC, depuis les annees 1980 la radiotherapie a pris une place croissante dans la prise en charge multidisciplinaire. Le traitement des formes localisees (stade I a III) repose sur l’association radiochimiotherapie. Si l’association concomitante de la radiotherapie et de la chimiotherapie fait aujourd’hui consensus, des questions demeurent concernant la dose optimale, le fractionnement et le traitement systemique a associer a la radiotherapie. Le traitement des formes metastatiques repose essentiellement sur une poly-chimiotherapie a base de sels de platine et d’etoposide. Le benefice d’un traitement local de la maladie intrathoracique au stade metastatique par l’irradiation thoracique de consolidation semble se preciser mais necessite des etudes de confirmation. L’irradiation prophylactique cerebrale (IPC) reste un standard dans les formes localisees chez les bons repondeurs mais sa place est plus controversee dans les stades metastatiques.

PO-0694: Lung toxicity modelling in thoracic post-operative RT for NSCLC and pleural mesothelioma

ESTRO 35 2016 ______________________________________________________________________________________________________ injection was monitored on real-time ultrasound using the probe on the endoscope. Patients were monitored for two hours before discharge. Daily cone beam CT (CBCT) images and 2D kV fluoroscopy (FS) images at fractions 2, 16 and 30 were acquired for setup and evaluation of marker visibility. Safety visits were planned twice during the RT course.