Lung Cancer

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TU_25_3568 - Medically Inoperable Early-Stage Lung Cancer Treated with Stereotactic Ablative Radiation Therapy (SABR): Multicenter Study of Turkish Radiation Oncology Group (TROG)

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Medically Inoperable Early-Stage Lung Cancer Treated with Stereotactic Ablative Radiation Therapy (SABR): Multicenter Study of Turkish Radiation Oncology Group (TROG)
B. Atalar1, E. Kaytan Saglam2, Z. Akgun3, U. Abacioglu4, A. Arifoglu5, B. Şahin1, E. Ozyar1, G. Yaprak6, N. Ozseker7, E. Kocak8, S. Karaman9, S. Igdem10, U. Selek11, H. F. Dincbas12, M. Sengoz1, S. B. Yucel1, A. N. Demiral13, and S. Akyurek14; 1Acibadem University, Department of Radiation Oncology, Istanbul, Turkey, 2Istanbul University, Institute of Oncology ; Memorial Şişli Hospital, Department of Radiation Oncology, Istanbul, Turkey, 3Memorial Şişli Hospital, Department of Radiation Oncology, İstanbul, Turkey, 4Acibadem Altunizade Hospital, İstanbul, Turkey, 5Acibadem Altunizade Hospital, Istanbul, Turkey, 6Kartal Lutfi Kirdar Research and Training Hospital, Department of Radiation Oncology, İstanbul, Turkey, 7Kartal Lutfi Kirdar Training and Research Hospital, istanbul, Turkey, 8Medipol University, Department of Radiation Oncology, Istanbul, Turkey, 9Istanbul University, Department of Radiation Oncology, Istanbul, Turkey, 10Istanbul Bilim University, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey, 11MD Anderson Radiation Oncology Outreach Center at American Hospital, Istanbul, Turkey, 12Cerrahpasa School of Medicine, Department of Radiation Oncology, Istanbul, Turkey, 13Dokuz Eylul University, Department of Radiation Oncology, Izmir, Turkey, 14Ankara University, Department of Radiation Oncology, Ankara, Turkey

Purpose/Objective(s): To review treatment outcomes for SABR in medically inoperable early stage lung cancer (NSCLC) patients treated by Turkish Radiation Oncology Group (TROG) member centers.

Materials/Methods: Between 2009 and 2017, a total of 386 patients with NSCLC treated with SABR in 12 TROG centers. Patient, disease, and treatment related prognostic factors were analyzed. Primary endpoints were, overall survival (OS), progression free survival (PFS), local control (LC) and regional control (RC) and radiation-related toxicities.

Results: Median follow-up was 15 months. The median age at diagnosis was 72 years (43-93) and 79% were men. Median tumor size was 30 mm (5 - 78 mm). Seventy-two percent of the patients have histologically confirmed diagnosis whereas 28% of patients were treated with clinical and radiological findings only without pathological diagnosis. Staging was as follows; T1N0 in 215, T2N0 in 166, T3N0 in 2 and T4N0 in 3 patients because of bilaterally tumors. Median SABR dose was 54Gy (30-70Gy), corresponding to a biological equivalent dose (BED) of 112Gy (48 - 180Gy) administered in median 5 (1-10) fractions. Response evaluation was made either with PET/CT or CT in median 3 months after SABR and complete response, partial response, stable disease and progression rates were 48%, 36%, 5.7% and 0.5%, respectively. The cumulative locoregional failure rate was 15%. Among these, 23 were local (6%) and 35 regional (9%) failures. Distant failure was reported in 67 (17%) patients. One to 3 years LC and RC rates were 97%, 91% and 93%, 86%, respectively. One and 3 years PFS and OS were 88%, 72% and 90%, 65%, respectively. At their last follow up 271 patients (71%) were alive. Prognostic factors associated with LC, RC and OS were summarized in table 1. No severe acute side effects were observed. Overall 18 patients experienced ≥ grade 3 pneumonitis, 11 patients had chest wall pain and 1 patient had rib fracture.

Conclusion: The results of this retrospective study have shown that SABR is a promising technique with satisfactory LC and OS rates and minimal toxicity in patients with medically inoperabl NSCLC. Table 1: Prognostic factors affecting overall survival and recurrence
Univariate Multivariate
Local Control @ 3 years
BED10 ≥90Gy BED10 ≥90, 92% BED10 <90, %71 p=0.003 HR:3.6, 95% CI (1.3-9.9) p=0.011
Tumor Size (17mm) ≤17mm, 100% >17mm, 89% p=0.035 p=0.98
Histology (Squamous/Adeno) Adeno, 96% Squamous, 88% p=0.006 HR:2.2, 95% CI (1.2-4.0) p=0.008
PET/CT Response (Complete/Partial) CR, 96% PR, 74% p<0.0001 HR:3.5, 95% CI (1.6-7.5) p=0.002
Regional Control @ 3 years
Tumor Size (30mm) ≤30mm, 95.5% >30mm, 77.5% p=0.025 HR:2.1, 95% CI (1.1-4.2) p=0.028
PET/CT Response (Complete/Partial) CR, 87% PR, 62% p<0.033 p=0.06
Overall Survival @ 3 years
Tumor Size (28mm) ≤28mm, 69,6% >28mm, 59,8% p=0.009 HR:1.6;95% CI (1-2.5) p=0.03
BED, Biological Effective Dose; HR,Hazard Ratio; CR, Complete Response; PR, Partial response

Author Disclosure: B. Atalar: None. E. Kaytan Saglam: None. Z. Akgun: None. U. Abacioglu: None. A. Arifoglu: None. N. Ozseker: None. U. Selek: Member of Board of Directors; Turkish Society for Radiation Oncology, Turkish Society of Lung Cancer.

Banu Atalar, MD

Biography:
Banu ATALAR, Assoc. Prof, M.D.
University of Acibadem
Department of Radiation Oncology

Mrs. Atalar has completed her undergraduate education in Iskenderun and graduated from Istanbul University, Istanbul Medical Faculty with MD degree in 1999 in Turkey. Her Radiation Oncology training was between 2000-2004 in Istanbul University, Cerrahpasa Medical Faculty, Radiation Oncology Department. During her residency she was awarded with Turkish Society of Radiation Oncology Grant in 2003 and ASCO (American Society of Clinical Oncology) Foundation International Development and Education Award (I.D.E.A) in 2004.
Between 2005-2009 she has worked as a Radiation Oncology Specialist in American Hospital Istanbul. Since 2009 I have been working in Acibadem Maslak Hospital and Acibadem MAA University Radiation Oncology Department as an Academician and full time consultant. She has completed short-term clinical research fellowship in Stanford University, Radiation Oncology Department under guidance of Dr. John Adler and Dr. Scott Soltys in 2011 on stereotactic radiosurgery. Since 2013 she was appointed as an Associate Professor in Acibadem University. She is a member of ESTRO, ASCO, IASLC, Rare Cancer Network and Turkish Radiation Oncology Society, and has served as “Resource Stratified International Guideline Advisory Group Member” of ASCO between December 2013 to June 2018.
She recently has been awarded from IASLC with "International Mentoship Award" in September 2018.
Her main field of interest is central nerve system tumors, thorasic tumors and gastrointestinal cancer. Other than these she is a consultant for advanced techniques such as, intensity modulated radiotherapy (IMRT) and stereotactic radiotherapy (SRS) including adaptive stereotactic radiotherapy with MR-Linac.

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TU_25_3568 - Medically Inoperable Early-Stage Lung Cancer Treated with Stereotactic Ablative Radiation Therapy (SABR): Multicenter Study of Turkish Radiation Oncology Group (TROG)



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