ESTRO 36 Abstract Book

S658 ESTRO 36 _______________________________________________________________________________________________

serum CEA, SCC, Cyfra 21-1, and NSE levels were chosen as study variables. Results Increased levels of CEA, SCC, Cyfra 21-1, and NSE levels were detected in 52 (29%), 32 (18%), 61 (34%), and 81 (45%) patients, respectively. According to the histologic subgroup, patients with adenocarcinoma presented significantly higher levels of CEA at baseline than those with other histology. Significantly increased levels of SCC and Cyfra 21-1 at baseline were present in squamous cell carcinoma. Proportion of patients with increased NSE at baseline was higher in small cell carcinoma than other histology. For the group of 105 NSCLC patients, the median survival was 7 months for patients with increased post- CCRT NSE and 26 months for patients with normal post- CCRT NSE (p=0.002). For the group of 74 small cell carcinoma patients, the median survival was 7 months for patients with increased pre-CCRT NSE and 27 months for patients with normal pre-CCRT NSE (p<0.001). In the multivariate analysis, high level of NSE, histology, and tumor diameter were significantly correlated with worse survival. Conclusion These findings suggest that pre- and post-CCRT NSE levels exhibit prognostic values in patients with lung cancer undergoing definitive CCRT. The combined use of serum NSE may provide additional information for prognosis. EP-1219 Concomitant radiotherapy and TKI in EGFR mutant or ALK positive stage IV non-small cell lung cancer P. Borghetti 1 , M. Bonù 2 , E. Roca 3 , E. Salah 2 , A. Baiguini 2 , S. Pedretti 1 , M. Maddalo 1 , M. Buglione 2 , S. Magrini 2 1 Spedali Civili di Brescia, Radiation Oncology, Brescia, Italy 2 Brescia University, Radiation Oncology, Brescia, Italy 3 Spedali Civili di Brescia, Medical Oncology, Brescia, Italy Purpose or Objective To investigate the role of radiotherapy (RT) in the management of EGFR-mutant or ALK positive metastatic non-small cell lung cancer (NSCLC) treated with TKI at onset or after standard chemotherapy Material and Methods Clinical data of 50 patients (pts) treated with RT concomitant to TKI for EGFR-mutant or ALK positive NSCLC stage IV were revised. Overall survival (OS) and toxicities were analysed as endpoint of the study. Kaplan-Meyer curve and log-rank test were elaborated for analysis of survival, while chi-square test was calculated to compare different variables. Results A description of the series is reported in Table 1. Median age of pts was 65 years. Biological targeted therapy for EGFR-mutant and ALK positive metastatic NSCLC was used in 82% and 18% of cases. Three pts were submitted to 2 TKI. Stereotactic radiotherapy was performed in 9 pts, 8 of them were treated for oligoprogressive disease and 1 for palliation (p 0.00). RT was performed within 30 days before TKI, concomitant to TKI and within 30 days after TKI in 8, 33 and 9 cases. Median duration of biological targeted therapy in the whole series was 11.9 (0.4-59.1) months, while was of 9.7 (0.4-33.5), 14.2 (1.7-59.1) and 8.3 (4.6-17.9) months for pts treated with RT before, concomitant and after TKI, respectively. Median OS was 19.3 months and 1 and 2 yrs OS was 71.5% and 36.5%, respectively. Stereotactic RT group showed an apparent significant benefit in term of OS (p= 0.043). Fourteen pts reported G1-2 toxicities (7 neurological symptoms, 3 pain and 4 emesis), none determined the suspension of RT. No dermatitis were observed.

Conclusion Biological targeted therapy with TKI is a recent opportunity to treat stage IV NSCLC with EGFR mutations or ALK translocation but scarce data are available on the effects of combined treatment. Our analysis shows that RT concomitant to TKI is feasible and safe with satisfying OS and RT related toxicities were not higher than expected. EP-1220 Sites of recurrent disease and prognostic factors in SCLC patients treated with radiochemotherapy R. Bütof 1 , C. Gumina 2 , C. Valentini 1 , A. Sommerer 1 , S. Appold 1 , D. Zips 3 , S. Löck 4 , M. Baumann 1 , E.G.C. Troost 1 1 University Hospital and Medical Faculty Carl Gustav Carus Dresden, Department of Radiation Oncology, Dresden, Germany 2 San Raffaele Scientific Institute Milano, Department of Radiotherapy, Milano, Italy 3 Eberhard-Karls-Universität Tübingen, Department of Radiation Oncology, Tübingen, Germany 4 OncoRay, National Center for Radiation Research in Oncology, Dresden, Germany Purpose or Objective Concurrent radiochemotherapy (RCHT) is the standard treatment in locally advanced small cell lung cancer (SCLC) patients. Due to conflicting results on elective nodal irradiation (ENI) or selective node irradiation (SNI) there is no clear evidence on optimal target volumes. Therefore, the aims of this study were the evaluation of sites of recurrent disease in patients with limited stage SCLC undergoing radiochemotherapy to assess the feasibility and safety of SNI versus ENI and, moreover, the extraction of prognostic factors for loco-regional control, freedom from distant metastases and overall survival. Material and Methods A retrospective single-institution study was performed in 54 consecutive patients treated with RCHT. After state-of- the-art staging, all patients underwent three-dimensional conformal radiotherapy to a total dose of 45 Gy in twice- daily fractions of 1.5 Gy starting concurrently with the first or second chemotherapy cycle. The gross tumour volume (GTV) consisted of the primary tumour and SNI visualized on CT and/or FDG-PET, or confirmed by cytology. The clinical target volume (CTV) was obtained by expanding the GTV, adjusting it for anatomical boundaries, and electively adding the supraclavicular lymph node stations. Thereafter, the CTV was expanded to a planning target volume based on institutional guidelines. Follow-up consisted of a 3-monthly chest x-ray or CT-scan up to 5 years after RCHT. All sites of loco- regional recurrences were correlated to the initial tumour and dose delivered. The impact of potential prognostic variables on outcome was evaluated using the Cox- regression model.