ESTRO 38 Abstract book

S742 ESTRO 38

L. Krozkin 1 , I. Ospovat 2 , D. Machievsky 2 , E. Gez 2 , S. Soifer 2 , B. Corn 2 , Y. Natan Hoz 2 , O. Gutfeld 2 , D. Limon 2 1 Soroka Medical Center, Radiotheraphy, Beer Sheva, Israel ; 2 Tel aviv medical center, Rdiotherapy, Tel Aviv, Israel Purpose or Objective Bone metastases are a common event in patients with non- small cell lung cancer (NSCLC). One of the most common sites is the spinal column. The epidemiology of symptomatic spinal metastases in patients with NSCLC is not well described. The goal of this study was to describe this population of patients. Material and Methods Our database was retrospectively reviewed for patients treated with radiotherapy (RT) to spinal metastases from NSCLC, over a period of 2 years (2016-2017). From the database we documented patients, disease and treatment characteristics. Results 78 patients were treated with RT for NSCLC spinal metastases over a period of 2 years. Of the patients, 68% were male, the median age was 64.4 years. 81% were diagnosed with adenocarcinoma, 17% with squamous cell carcinoma. 11.5% of the patients have EGFR mutation, none had ALK mutation. The location of the metastases was thoracic spine in 62% of patients, 47% in lumbar spine, 31% in sacrum and 13% in cervical spine. 40% presented with lesions in more than one spinal sub-site. Median time from diagnosis of metastatic disease to first treatment of spinal metastases was 1.9months. The majority of patients (96%) were treated with a fractionation of 20-30Gy in 5-10 fractions, only 3 patients were treated with a single fraction of 8Gy, no patient was treated with stereotactic RT. About 10% were treated with a second course of RT, none to the same location. However, the two patients that required a third course of RT, were re-irradiated to previously treated lesions. Median survival was 5.5months for the entire cohort. Patients with EGFR mutation had better survival (12.7mo vs. 4.4mo, p=0.046). Other tumor, treatment and patient parameters, didn't influence survival. Conclusion The most pronounced findings in our cohort of patients with metastatic NSCLC and spinal metastases, treated with RT, was the short time from disease diagnosis to spinal treatment and the relative short survival, when compared to known survival of stage IV NSCLC. This suggest that spinal metastases in NSCLC may predict a more aggressive course of disease. EP-1358 SBRT for de novo pulmonary tumors in patients with completely resected early stage NSCLC Q. Zhao 1 , J. He 1 , Z. Zeng 1 1 Zhongshan Hospital- Fudan University, Department of radiation oncology, Shanghai, China Purpose or Objective Following surgery for early-stage non-small cell lung cancer (NSCLC), de novo pulmonary tumors are common. This study aimed to assess the efficacy, patterns of failure, and toxicity of stereotactic body radiotherapy (SBRT) in the treatment of de novo pulmonary tumors following curative resection of early stage NSCLC. Material and Methods We reviewed the medical data of patients who had received definitive intent SBRT for small lung cancer at Zhongshan Hospital, Fudan University, between June 2011 and December 2017. Patients who had experienced complete resection for prior early-stage NSCLC before SBRT were identified for further analysis. Incidences of loco-regional recurrence (LR) and distant metastasis (DM) were evaluated using the alternative cumulative incidence competing risk method. The probability of survival was estimated using the Kaplan–Meier method.

Conclusion Oligo-progressive status of lung tumors exhibits a less favorable survival outcome in metastatic patients with pulmonary oligo-recurrence treated by SABR. EP-1356 Targeted therapy with or without Radiotherapy in EGFR/ALK mutant NSCLC with Brain Metastases I. Císcar García 1 , M. Martín Martín 1 1 Ramon y Cajal Universitary Hospital, Radiation Oncology, Madrid, Spain Purpose or Objective The treatment of brain metastases of non-small cell lung cancer (NSCLC) especially those with EGFR and ALK mutation is controversial. TKIs may have more than 70% intracranial response rate in these patients, and delay radiotherapy until progression of disease has been proposed. The purpose of this study is to analyze the treatment and the results in our patients with brain metastasis of EGFR mutant or ALK positive NSCLC. Material and Methods Eligible patients were those diagnosed between January 2013 and December 2017 with brain metastases (found at diagnosis or at progression) from NSCLC. We registered the local and systemic progression and the type of treatment and moment received. We analyzed the brain progression free survival without radiation therapy (RT) and we compared the overall survival (OS) between patients treated with RT at diagnosis of the metastases and thoue who were treated at progression. Results 43 patients with NSCLC and EGFR/ALK mutation, presented brain metastases throughout the disease evolution. 29 (67'5%) had EGFR, 13 (30%) ALK 8 and 1 (2'3%) had ROS mutation. At diagnosis, those who had more than 3 brain metastases were 18 (62%) with EGFR mutation and 8 (57%) with ALK mutation. 21 patients (48.8%) were treated with initial radiotherapy and TKI, while in 16 patients (37.7%) the radiotherapy was delayed until the cerebral progression. 6 (14%) did not receive radiotherapy treatment: 3 of them because they died from the disease one month after diagnosis of brain metastases and were excluded for survival analysis. The type of radiotherapy used was holocraneal in 25 patients (58.1%), fractionated stereotactic in 4 patients (9.3%) and radiosurgery in 8 patients (18.6%). 5 received surgery and subsequent radiotherapy (2 fractionated and 3 radiosurgery). For patients with second-generation TKIs, the median lifetime of the communication of the cerebral results of diagnosis of brain metastasis was for 9 months and for the states with Erlotinib and Gefitinib or CT for 7 months. For patients with EGFR mutant tumors who were treated with delayed radiation therapy, the median time to brain progression was 7 months and 5 months for ALK and ROS. When they received radiotherapy at the diagnosis of brain metastases, the median to progression was the same for the two types of mutation, 13 months. The median overall survival for patients with EGFR mutation treated with RT at diagnosis of brain metastases was 16 months, while for patients as well as at 12 months, for ALK positive patients it was 21 and 23 months respectively, these differences were not significant. Conclusion Up front radiotherapy does not improve overall survival in patients with brain metastases of EGFR mutant or ALK positive non small cell lung cancer, but the potencial benefit of delaying radiotherapy must be balanced with the short time of brain progression. We haven’t found significant differences in the brain response between front and second-line TKIs. EP-1357 Spinal metastases from non-small cell lung cancer; is it a surrogate of bad outcome?