ESTRO 38 Abstract book

S751 ESTRO 38

Niyazi 1 , C. Belka 1 , F. Manapov 1 1 LMU University Hospital Grosshadern, Department of Radiation Oncology, Munich, Germany ; 2 Thoracic Oncology Centre Munich Ludwig-Maximilians University, Division of Respiratory Medicine and Thoracic Oncology Department of Internal Medicine V, Munich, Germany Purpose or Objective The Eastern Cooperative Oncology Group performance score (ECOG-PS) is widely used in clinical routine to quantify patients’ general condition. We evaluated ECOG- PS before, after and its alteration in the course of chemoradiotherapy (CRT) in patients with stage III non- small cell lung cancer (NSCLC). Material and Methods The data of ninety-eight patients with NSCLC of UICC 7 th edition stage IIIA/B and performance status ECOG 0-1 before treatment was evaluated. ECOG-PS before treatment, on first medical aftercare and the difference between, was examined for their impact on overall survival (OS) from initial diagnosis and time to local progression (TTLP), time to distant metastasis (TTDM) and event free survival (EFS) from the first day of irradiation. Results The majority of patients were treated with concurrent (79%) or sequential (11%) chemoradiotherapy, while 51% received induction chemotherapy. Median survival for the entire cohort was 20.8 (range: 15.3-26.2) months. Our cohort consisted of 62% males and 38% females. Before treatment ECOG-PS was 0 in 48% and 1 in 52% of patients, their median OS, one-year and two-year survival was 26.4 months, 85%, 53% and 18.9 months, 69%, 37% (p=0.108). After completion of CRT ECOG-PS was 0 in 34%, 1 in 46%, 2 in 18% and 3 in 2% of patients, median OS, one-year and two-year survival was 40.3 months, 88%, 64% for ECOG-PS 0, 19.3 months, 82%, 40% for ECOG-PS 1, 11.9 months, 50%, 28% for ECOG-PS 2 and 7.6 months, 0%, 0% for ECOG- PS 2 (p<0.001). During treatment ECOG-PS remained the same in 62%, was reduced by one in 3% and was increased by one in 30% and by two in 5 % of patients. Taken together, 65% of patients had the same or better (=stable) and 35% of patients had worse ECOG-PS after CRT, with median OS, one-year and two-year survival of 29.3 months, 84%, 53% and 13.7 months, 62%, 29%, respectively (p<0.001). Increase of ECOG-PS during treatment impaired OS in both patient subgroups with initial ECOG-PS 0 (p=0.005, median OS 19.1 vs 31.4 months) and 1 (p=0.001, median OS 22.9 vs 11.1 months). Distant metastasis (DM) were diagnosed in 40 patients after completion of CRT. ECOG-PS before and after CRT did not predict occurrence of DM. Patients with an ECOG-PS increase during treatment however showed significantly more distant metastasis (53% vs 35%) with a median TTDM of 9.1 months (p<0.001). EFS was not affected by ECOG-PS before treatment but was impaired by ECOG-PS increase during CRT with median EFS of 9.4 vs 7.7 months (p=0.049) and by ECOG-PS after CRT with median EFS of 9.6 months, 9.0 months, 7.9 months and 3.5 months for ECOG-PS 0, 1, 2, 3, respectively (p=0.018). TTLP was not affected by ECOG- PS before and after treatment or ECOG-PS increase during ECOG-PS and its changes have a strong impact on patients’ outcome. Reduction of performance status was a significant negative factor for patients’ probability to develop DM, for EFS and OS. EP-1375 Heterogeneity score in inoperable stage III NSCLC patients treated with definitive chemoradiotherapy J. Taugner 1 , L. Käsmann 1 , C. Eze 1 , M. Dantes 1 , O. Roengvoraphoj 1 , K. Gennen 1 , M. Karin 1 , A. Tufman 2 , M. Niyazi 1 , C. Belka 1 , F. Manapov 1 1 LMU University Hospital Grosshadern, Department of Radiation Oncology- Munich- Germany., München, treatment. Conclusion

Germany ; 2 Thoracic Oncology Centre Munich Ludwig- Maximilians University, Division of Respiratory Medicine and Thoracic Oncology Department of Internal Medicine V, Munich, Germany Purpose or Objective Stage III non-small cell lung cancer (NSCLC) represents a very heterogeneous disease regarding principal patient- and tumor characteristics. In clinical routine, a simple heterogeneity score may further aid in personalizing The data of ninety-nine consecutive patients with performance status ECOG 0-1 treated until the end of 2016 with multimodal approach for inoperable NSCLC (UICC 7 th edition stage IIIA/B) were evaluated. Patient- and tumor- related factors were examined for their impact on overall survival. Factors showing a significant negative association with patient prognosis were scored with one point each. Three subgroups with low, intermediate and high risk (0- 1, 2-3 and 4-5 points) score were defined. The results were then validated in our own prospective cohort, which started January 2017 and includes 35 patients with at least one year of follow-up. Results The majority of patients were treated with concurrent (78%) or sequential (11%) chemoradiotherapy, while 53% received induction chemotherapy. Median survival for the entire cohort was 20.8 (range: 15.3-26.3) months. Age (p=0.020), gender (p=0.007), cumulative pack years (PY) (p=0.015), tumor-associated atelectasis (p=0.004) and histology (p=0.004) were shown to have a significant impact on survival. 12, 59 and 28 patients were defined to have a low, intermediate and high-risk heterogeneity score. Median survival, 1-, 2- and 3-year survival rates were distributed as follows: not reached, 100%, 83% and 67% in the low, 22.9 (16.3-29.5) months, 80%, 47% and 24% in the intermediate and 13.7 (11.1-16.3) months, 57%, 25% and 18% in the high-risk subgroup, respectively (p<0.001). Even though median survival was not yet reached in our validation cohort (low risk: 4; intermediate risk: 15; high risk: 16 patients), it has revealed a one-year survival trend with 100% for the low risk, 93% for the intermediate risk and 69% for the high risk subgroup (p=0.100). Conclusion A simple heterogeneity score was developed for inoperable stage III NSCLC patients with good performance status receiving multimodal therapy. The score may aid physicians to infer clinical outcomes and optimize everyday decision-making as well as planning of prospective studies. EP-1376 Robotic SBRT with fiducial tracking for medically inoperable peripheral stage I NSCLC: final report S. Kataria 1 , N. Aghdam 1 , M. Repka 2 , M. Marin 3 , L. Campbell 1 , S. Suy 1 , S. Collins 1 , E. Anderson 4 , J. Lischalk 1 , B. Collins 1 1 Georgetown University Hospital, Radiation Medicine, Washington DC, USA ; 2 NYU Winthrop Hospital, Radiation Oncology, Mineola- New York, USA ; 3 New York Medical College-Metropolitan Hospital, Internal Medicine, New York- NY, USA ; 4 Georgetown University Hospital, Pulmonary & Critical Care Medicine, Washington DC, USA Purpose or Objective Published data have demonstrated robotic SBRT with fiducial tracking to be an effective alternative treatment for medically inoperable patients with peripheral Stage I NSCLC. Limited data, however, is available regarding the long term outcomes associated with using this technique. Here we report our institutional experience treating this patient population. Material and Methods multimodal therapy. Material and Methods