L. Pemberton

Accelerated hypo-fractionated radiotherapy for non small cell lung cancer: results from 4 UK centres.

BACKGROUND AND PURPOSE A variety of radiotherapy fractionations are used as potentially curative treatments for non-small cell lung cancer. In the UK, 55 Gy in 20 fractions over 4 weeks (55/20) is the most commonly used fractionation schedule, though it has not been validated in randomized phase III trials. This audit pooled together existing data from 4 UK centres to produce the largest published series for this schedule. MATERIALS AND METHODS 4 UK centres contributed data (Cambridge, Cardiff, Glasgow and Sheffield). Case notes and radiotherapy records of radically treated patients between 1999 and 2007 were retrospectively reviewed. Basic patient demographics, tumour characteristics, radiotherapy and survival data were collected and analysed. RESULTS 609 patients were identified of whom 98% received the prescribed dose of 55/20. The median age was 71.3 years, 62% were male. 90% had histologically confirmed NSCLC, 49% had stage I disease. 27% had received chemotherapy (concurrent or sequential) with their radiotherapy. The median overall survival from time of diagnosis was 24.0 months and 2 year overall survival was 50%. CONCLUSION These data show respectable results for patients treated with accelerated hypo-fractionated radiotherapy for NSCLC with outcomes comparable to those reported for similar schedules and represent the largest published series to date for 55/20 regime.

Accelerated Radical Radiotherapy for Non-small Cell Lung Cancer using Two Common Regimens: a Single-centre Retrospective Study of Outcome

AIMS A variety of radical radiotherapy regimens are in use for non-small cell lung cancer. Continuous hyperfractionated accelerated radiotherapy (CHART: 54 Gy in 36 fractions over 12 days) and accelerated hypofractionated radiotherapy using 55 Gy in 20 fractions over 4 weeks are standard fractionations in our centre. The primary aim of this retrospective study was to evaluate survival outcome seen in routine clinical practice. MATERIALS AND METHODS All case notes and radiotherapy records of radically treated patients between 1999 and 2004 were retrospectively reviewed. Basic patient demographics, tumours, characteristics, radiotherapy and survival data were collected. RESULTS In total, 277 patients received radical radiotherapy: 137 and 140 patients received CHART and hypofractionated radiotherapy, respectively. There were differences noted in the demographics between the two treatment schedules: median age 65 years (range 41-83) vs 73 years (range 33-87); histological confirmation rates 90% vs 76%; prior chemotherapy 34% vs 19% for CHART and hypofractionated treatment, respectively. For CHART patients, stages I, II, III and unclassified were 12, 8, 68 and 12% and the staging for the hypofractionated regimen was 54, 11, 34 and 2%, respectively. The median overall survival from the time of diagnosis was 20.4 months with a 40% 2-year survival rate. For the two fractionations the median survival was 16.6 months vs 21.4 months and 34% vs 45% of patients were alive at 2 years in the CHART and hypofractionated groups, respectively. On multivariate analysis, stage was the only factor affecting overall survival - no difference was seen according to radiotherapy regimen. CONCLUSION This single-centre study reflects the outcome of unselected consecutively treated non-small cell lung cancer patients. Adjusting for stage, there was no significant difference in survival seen according to regimen. Encouragingly, CHART outcome shows reproducibility with the original CHART paper. Our hypofractionated outcome is similar to that previously reported, but despite this being the UKs most common regimen, 55 Gy in 20 daily fractions remains unvalidated by phase III trial data.

The largest UK single centre series using hypofractionated radical radiotherapy for NSCLC in the very elderly.

The proportion of NSCLC cases occurring in very elderly patients over 80 years) is increasing [1]. There is concern that this group ay benefit less from radical treatment and there is little data vailable of post treatment overall survival (OS). We have recently reformed a single centre review of our outcomes for this group ver a five year period and the effect of pre-treatment status on S. A total of 138 consecutively identified patients over the age of 0 were reviewed. Each was treated between 2007 and 2011 and eceived 55 Gy in 20 fractions, the UK’s most common regime. The mean age of patient at treatment was 83.9 years (range 0.0–94.8) and 59% of patients were male. ECOG pre-treatment erformance status was recorded in 91 patients (0 5.6%, I 51.6%, II 4.0%, III 8.8%). Formal histological diagnosis was available in 40% of

Benefit of using motion compensated reconstructions for reducing inter-observer and intra-observer contouring variation for organs at risk in lung cancer patients

BACKGROUND AND PURPOSE In lung cancer patients, accuracy in contouring is hampered by image artefacts introduced by respiratory motion. With the widespread introduction of 4DCT there is additional uncertainty caused by the use of different reconstruction techniques which will influence contour definition. This work aims to assess both inter- and intra-observer contour variation on average and motion compensated (mid-position) reconstructions. MATERIAL AND METHODS Eight early stage non-small cell lung cancer patients that received 4DCT were selected and these scans were reconstructed as average and motion compensated datasets. 5 observers contoured the organs at risk (trachea, oesophagus, proximal bronchial tree, heart and brachial plexus) for each patient and each reconstruction. Contours were compared against a STAPLE volume with distance to agreement metrics. Intra-observer variation was assessed by redelineation after 4 months. RESULTS The inter-observer variation was significantly smaller using the motion compensated datasets for the trachea (p = 0.006) and proximal bronchial tree (p = 0.004). For intra-observer variation, a reduction in contour variation was seen across all organs at risk in using motion compensated reconstructions. CONCLUSIONS This work shows that there is benefit in using motion compensated reconstructions for reducing both inter-observer and intra-observer contouring variations for organs at risk in lung cancer patients.

The use of volunteers to implement electronic patient reported outcomes in lung cancer outpatient clinics

Highlights • 104 eligible lung cancer patients were approached, 86 (83%) consented to take part.• At 1st attempt 69% of patients completed the ePRO questionnaire without assistance.• Assistance was defined as verbal/physical help to complete the ePRO questionnaire.• Most patients requiring help had a companion that could have provided assistance.• More patients preferred electronic than paper questionnaires.

167: Thoracic radiotherapy in extensive stage small cell lung cancer

167 Thoracic radiotherapy in extensive stage small cell lung cancer M.A. Harris1 *, P. Holland2, R. Hogley2, P.A. Burt3, C. Faivre-Finn3, N. Bayman3, L. Pemberton3, L.W. Lee3, J.H. Coote3, H.Y. Sheikh3, A.Z. Chittalia4, F. Blackhall5, R. Califano5, Y. Summers5, P. Taylor5. 1Clinical Oncology, The Christie Hospital, Manchester, United Kingdom, 2Medical School, Manchester University, Manchester, United Kingdom, 3Department of Radiation Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom, 4Medicine, University of Manchester, Manchester, United Kingdom, 5Medical Oncology, The Christie Hospital, Manchester, United Kingdom

152 The impact of IMRT on the treatment of patients with N3M0 lung cancer at The Christie

Methods: Patients with non-small cell lung cancer treated with 36Gy in 12 fractions over the last 2 and half years were identified via the Varian patient manager treatment system. Demographic, histopathological, clinical and toxicity data were collected from patient records and hospital IT systems. Data were anonymised and analysed by the authors. Results: The total number (N) of patients available for analysis was 56. The results are summarised in the table. The median age of patients at the start of treatment was 70 years (range 37 85 years). Post-radiotherapy haemoptysis was reported in 3 patients (5.1%). No patient developed myelopathy. The commonest described toxicity was dysphagia, but only 3 (6.9%) developed grade 3 dysphagia. Most patients were treated with radiotherapy via an AP-PA parallel opposed pair, median field size was 120.96 cm2 (range 75.5 209.33 cm2), consistent with the comparator where field size did not normally exceed 200 cm2. Conclusions: High dose palliative radiotherapy in Oxford University’s NHS Trust is safe and tolerable with no radiation induced myelopathy. The main toxicity of dysphagia is generally non-severe. The median survival of patients is comparable to the 9 month survival seen in the 13 fraction arm of the MRC Trial, indicating a genuine application to everyday radiotherapy practice.

1260POUTCOMES OF ELDERLY PATIENTS (≥70 YO) WITH ADVANCED NON-SMALL CELL LUNG CANCER (NSCLC): A MULTI-INSTITUTIONAL ANALYSIS

ABSTRACT Aim: Themajority of advanced NSCLC patients (pts) are ≥70 years old. International guidelines recommend use of single agent chemotherapy or, for fit patients with good organ function, platinum-based doublets. This patient group is under-represented in clinical trials and undertreated in clinical practice. Methods: We retrospectively analysed all consecutive pts with advanced NSCLC and ≥70 yo treated at The Christie, Manchester, UK and San Luigi Hospital, Turin, Italy between January 2007 and December 2012. Data retrieved: demographics, performance status (PS), type of treatment, lines of treatment, response rate (RR) and date of progression/death. Primary outcome: percentage (%) of pts receiving systemic anticancer treatment (SACT). Secondary outcomes: % receiving palliative RT or best supportive care (BSC) only, % of pts stopping treatment due to toxicity, RR from first-line systemic ant-cancer therapy (SACT) and median overall survival (OS) calculated with Kaplan-Meier curves. Results: 623 pts were identified. Median age was 75 (range 70-93), 63.4% were male. PS was 0, 1, 2, 3, 4 and unknown in 20.9%, 26.3%, 30%, 20.7%, 1.9% and 0.2% of pts, respectively. Histology: Adenocarcinoma/Squamous/Bronchialveolar carcinoma/NOS: 34.7%/34.2%/26.5%/0.8%/3.8%. 3% of all pts (11% of tested non-squamous) were EGFR mutant. Treatment given: SACT (37%), palliative RT (45%) and BSC (18%). First-line SACT: single agent gemcitabine, vinorelbine, carboplatin, etoposide, pemetrexed and docetaxel (17.8%), platinum based-doublet 76.5%; (carboplatin-based 69.1%, cisplatin-based 7.4%) and gefitinib/erlotinib (EGFR-TKI) (5.7%). Treatment was stopped due to toxicity in 7.9% of pts (all had chemotherapy). Response rate to first-line: PR 9.8%, SD 20%. Second-line and third-line treatment were given to 9.8% and 3% of patients, respectively. Median OS was 10.4, 6.7, 17.8, 4.7 and 2.3 months for doublet chemotherapy, single agent chemotherapy, EGFR-TKI, palliative radiotherapy and BSC, respectively. Conclusions: In our series, 37% of pts received SACT with good tolerability. OS was in keeping with reported series unselected with regards to age; highlighting that fit elderly pts can tolerate and benefit from SACT. Disclosure: All authors have declared no conflicts of interest.