ESTRO 36 Abstract Book

S654 ESTRO 36 _______________________________________________________________________________________________

South Wales, Sydney, Australia 3 William Buckland Radiotherapy Centre, The Alfred Hospital, Melbourne, Australia 4 Monash University, Melbourne, Victoria, Australia 5 Ingham Institute of Applied Medical Research, Medical Physics, Sydney, Australia 6 Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia 7 Institute of Medical Physics- School of Physics, University of New South Wales, Sydney, Australia 8 Western Sydney University, Sydney, New South Wales, Australia Purpose or Objective Clinical practice guidelines based on evidence derived from clinical trials are used to guide management of patients with non-small cell lung cancer (NSCLC). However patients enrolled in trials must fulfil various eligibility criteria, and may not represent the wider patient population. The aim of this study was to review eligibility criteria of clinical trials performed in patients with NSCLC and compare the characteristics of an Australian clinical patient cohort against these criteria. Material and Methods A systematic Medline & Embase search was conducted to identify all randomized clinical trials published in English from 2005-2014 concerning curative radiotherapy for Stage I-III NSCLC. Trials on stereotactic ablative radiotherapy, brachytherapy, post-operative radiotherapy or adjuvant therapy were excluded. Eligibility criteria for entry into these trials were evaluated. A database of contemporaneous NSCLC patients from the Liverpool and Macarthur Cancer Therapy Centres in Sydney, Australia, and from the William Buckland Radiotherapy Centre at the Alfred Hospital in Melbourne, Australia, was reviewed. Results Twenty-two trials were identified. Performance status was a defined eligibility criterion in all trials, with twelve trials limiting this to ECOG 0-1 and ten to ECOG 0-2. Seventeen trials specified eligibility by age, with five excluding patients >70-80 years. Weight loss was specified in nine trials, being ≤5% in three trials, and ≤10% in six trials. Eight trials excluded patients with cardiac co- morbidity. All trials included use of chemotherapy, so blood test parameters were used for inclusion. Twelve trials had minimum pulmonary function/blood oxygenation requirements for entry. Fourteen trials excluded patients with a history of previous cancer in the past three years. There were 366 patients treated with curative radiotherapy for NSCLC in the featured cancer centres from 2005-2014. Clinical trial eligibility criteria were not met in 66 patients (18%) because of performance status, and in 60 (16%) because of weight loss. 162 (44%) would have been excluded because of cardiac co-morbidity, and 41 (11%) would have been excluded because of prior cancer. When considering one of the highest impact trials published during the study period - RTOG 9410 - key inclusion criteria were Stage II, IIIA or IIIB NSCLC patients with ECOG PS 0, 1 or 2, ≤5% weight loss, serum creatinine level ≤1.5g/L, and no prior thoracic or neck radiotherapy. There were 268 clinic patients classified as Stage II, IIIA or IIIB, and trial entry criteria would have rendered 61 (23%) of these patients ineligible for trial enrolment. Conclusion Patients enrolled in trials for NSCLC are highly selected and do not reflect the clinic population, leading to uncertainty about the applicability of clinical practice guidelines in some patients.

therapy, but only one did not have completely remission of symptoms in 30 days after the beginning, evolving with pathologic rib fracture that got better after four months. Conclusion This series suggests that SBRT with dose of 40 Gy in 4 fractions (BED 10 = 80Gy 10 ) twice a week, is safe and effective for metastatic lung lesions and can be considered for prospective clinical trials to be tested as a reasonable option of dose fractionation. F. Martucci 1 , P. Fanti 1 , B. Muoio 1 , S. Cima 1 , C. Azinwi 1 , K. Yordanov 1 , G. Pesce 1 , M.C. Valli 1 , S. Presilla 2 , A. Richetti 1 1 Istituto Oncologico della Svizzera Italiana, Radiation Oncology, Bellinzona, Switzerland 2 Ente Ospedaliero Cantonale, Medical Physics Service, Bellinzona, Switzerland Purpose or Objective Stereotactic body radiotherapy (SBRT) is a method of external beam radiotherapy that accurately delivers a high irradiation dose to an extracranial target in one or few treatment fractions. Based on current evidence, SBRT is a valid and curative treatment for unresectable lung nodules. Aim of this study is to evaluate the efficacy and toxicity of SBRT in pts with early lung cancer and metastatic pulmonary lesions. Material and Methods We retrospectively analysed data of 41 consecutive pts with lung nodules treated in our centre from September 2011 to December 2015. Demographic patient data and dosimetric data regarding SBRT treatments were collected. Acute toxicity (defined as toxicity < 45 days) and late toxicity (defined as toxicity > = 45 days) were reported and graded as per standardized CTCAE 4.0 criteria. Progression free survival (PFS) and overall survival (OS) were also described. Results The median age was 71 years (range 52-90). Twenty pts were diagnosed with primary or recurrent lung cancer, 21 pts had metastatic lung nodules of varying histologies. Thirty pts had an histologically proven diagnosis, while the remainder were treated after multidisciplinary decision in the face of suspicious PET/CT imaging. The median follow up was 29 months (range 3-56). The treatment was delivered with a Biologically Effective Dose (BED10) ≥ 90 GyE, in 3 to 6 fractions, with volumetric modulated arcs with flattening filter free beams. The median Planning Target Volume (PTV) was 13.1 cm 3 (range 4.6-70). OS at 1 and 2 years was 91.8% and 85.7%, respectively. PFS at 1 and 2 years was 91.7% and 81.5%, respectively. No statistical significative difference in terms of OS e PFS was found between primary and metastatic lesions setting (p=. 0.098 and p=0.520). Nine of 41 pts had a relapse, and among them only 1 patient showed a recurrence inside the irradiated field. No acute toxicities were registered. Late toxicity was recorded in 2 pts: a grade 2 pneumonitis and a grade 1 rib fracture. Conclusion SBRT delivered using linac-based flattening filter free volumetric modulated arc radiotherapy is feasible and well tolerated. Our experience confirm excellent long- term local control rates and a very low rate of late toxicity. EP-1211 How selected are patients in clinical trials of radiotherapy for non-small cell lung cancer? M. Berry 1,2 , K. Neville 1 , J. Ruben 3,4 , L. Holloway 1,2,5,6,7 , S. Vinod 1,2,8 1 Liverpool Cancer Therapy Centre, Radiation Oncology, Sydney, Australia 2 South Western Sydney Clinical School, University of New EP-1210 SBRT with FFF Beams and V-MAT for lung cancer. A mono-institutional experience.