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Outcomes After Stereotactic Ablative Radiotherapy (SABR) of Early Stage Non-Small Cell Lung Cancers Without Biopsy Proven Disease
Purpose: SABR has become the standard of care for inoperable early stage non-small cell lung cancer. Many patients are unable to safely receive a biopsy given poor pulmonary function with underlying emphysema and thus are empirically treated with radiotherapy. This study was performed to evaluate the efficacy and safety of definitive SABR in this population.
Methods: 69 patients were analyzed with a median follow up of 18 months. Patient, tumor, radiation doses, pulmonary function tests (including subgroups with FEV1 < 1.0 L, FEV1 < 1.5 L, FEV1 < 30%, and FEV1 < 35%) and toxicity (acute ≤ 90 days and late > 90 days) were analyzed to find associations between overall survival (OS) on Kaplan-Meier log-rank testing and differences in the patient populations with Chi- Square and Mann-Whitney U tests.
Results: The median age was 71. Sixty two tumors were peripheral (88.6%). There were 4 local recurrences (5.7%), 10 regional (different lobe and nodal) failures (14.29%), 15 distant metastases (21.4%) and a median survival of 17 months. There were differences in OS based on operability status (P=0.031), acute toxicity (P=0.000), and acute grade 2 toxicity (P=0.003). Significant factors for differences in distribution among patients with and without acute toxicity were O2 dependence (P=0.047), long term toxicity (P=0.000), and long term grade 2 toxicity (P=0.000). In the acute grade 2 toxicity analysis, O2 dependence (P=0.003), central vs peripheral location (P=0.000), new O2 requirement (P=0.022), long term toxicity (P=0.004), and long term grade 2 toxicity P=0.010) were significant. There were no significant differences based on pulmonary function testing (FEV1, FVC, or DLCO) or the analyzed PFT subgroups.
Conclusion: Operability and acute toxicity are associated with differences in OS in those patients undergoing empiric SABR. O2 dependence prior to treatment and not PFT parameters were associated with acute toxicities.
Purpose: SABR has become the standard of care for inoperable early stage non-small cell lung cancer. Many patients are unable to safely receive a biopsy given poor pulmonary function with underlying emphysema and thus are empirically treated with radiotherapy. This study was performed to evaluate the efficacy and safety of definitive SABR in this population.
Methods: 69 patients were analyzed with a median follow up of 18 months. Patient, tumor, radiation doses, pulmonary function tests (including subgroups with FEV1 < 1.0 L, FEV1 < 1.5 L, FEV1 < 30%, and FEV1 < 35%) and toxicity (acute ≤ 90 days and late > 90 days) were analyzed to find associations between overall survival (OS) on Kaplan-Meier log-rank testing and differences in the patient populations with Chi- Square and Mann-Whitney U tests.
Results: The median age was 71. Sixty two tumors were peripheral (88.6%). There were 4 local recurrences (5.7%), 10 regional (different lobe and nodal) failures (14.29%), 15 distant metastases (21.4%) and a median survival of 17 months. There were differences in OS based on operability status (P=0.031), acute toxicity (P=0.000), and acute grade 2 toxicity (P=0.003). Significant factors for differences in distribution among patients with and without acute toxicity were O2 dependence (P=0.047), long term toxicity (P=0.000), and long term grade 2 toxicity (P=0.000). In the acute grade 2 toxicity analysis, O2 dependence (P=0.003), central vs peripheral location (P=0.000), new O2 requirement (P=0.022), long term toxicity (P=0.004), and long term grade 2 toxicity P=0.010) were significant. There were no significant differences based on pulmonary function testing (FEV1, FVC, or DLCO) or the analyzed PFT subgroups.
Conclusion: Operability and acute toxicity are associated with differences in OS in those patients undergoing empiric SABR. O2 dependence prior to treatment and not PFT parameters were associated with acute toxicities.
Purpose: SABR has become the standard of care for inoperable early stage non-small cell lung cancer. Many patients are unable to safely receive a biopsy given poor pulmonary function with underlying emphysema and thus are empirically treated with radiotherapy. This study was performed to evaluate the efficacy and safety of definitive SABR in this population.
Methods: 69 patients were analyzed with a median follow up of 18 months. Patient, tumor, radiation doses, pulmonary function tests (including subgroups with FEV1 < 1.0 L, FEV1 < 1.5 L, FEV1 < 30%, and FEV1 < 35%) and toxicity (acute ≤ 90 days and late > 90 days) were analyzed to find associations between overall survival (OS) on Kaplan-Meier log-rank testing and differences in the patient populations with Chi- Square and Mann-Whitney U tests.
Results: The median age was 71. Sixty two tumors were peripheral (88.6%). There were 4 local recurrences (5.7%), 10 regional (different lobe and nodal) failures (14.29%), 15 distant metastases (21.4%) and a median survival of 17 months. There were differences in OS based on operability status (P=0.031), acute toxicity (P=0.000), and acute grade 2 toxicity (P=0.003). Significant factors for differences in distribution among patients with and without acute toxicity were O2 dependence (P=0.047), long term toxicity (P=0.000), and long term grade 2 toxicity (P=0.000). In the acute grade 2 toxicity analysis, O2 dependence (P=0.003), central vs peripheral location (P=0.000), new O2 requirement (P=0.022), long term toxicity (P=0.004), and long term grade 2 toxicity P=0.010) were significant. There were no significant differences based on pulmonary function testing (FEV1, FVC, or DLCO) or the analyzed PFT subgroups.
Conclusion: Operability and acute toxicity are associated with differences in OS in those patients undergoing empiric SABR. O2 dependence prior to treatment and not PFT parameters were associated with acute toxicities.
Evaluation of Acute Toxicity in Treating Pelvic Lymph Nodes With Prostate Boost With Hypofractionated Simultaneous Integrated Boost (SIB) Using Volumetric Arc Therapy (VMAT)
Purpose: It is conventional to treat pelvic lymph nodes, followed by prostate boost in a sequential manner, requiring 8-9 weeks to complete therapy. In the last several years there have been several randomized studies of implementing moderate hypofractionated radiotherapy in prostate cancer to shorten the treatment time, which has proven to be non-inferior to conventional treatment. The purpose of this retrospective study is to evaluate the acute toxicities of hypofractionated SIB radiotherapy in treating the lymph nodes with prostate boost.
Methods: Between 2015 and 2017, twenty five high risk prostate cancer patients received pelvic node radiotherapy with prostate boost in 25 fractions with SIB technique with neo-adjuvant and concurrent hormone therapy to 50 Gy/25 fractions at 2 Gy/fraction to pelvic nodes and prostate boost for a total of 67.5 - 75 Gy at 2.7 to 3.0 Gy/fraction. We followed QUNTAC dose-volume constraints for the rectum, bladder and bowel. All these patients received long-term hormone therapy.
Results: The median age was 66 years (range 57-81 years). There were 6 stage II C, 7 III A, 15 III C, and 1 stage IV A. All patients were restaged as per American Joint Committee on Cancer 8th edition. Gleason Score: 6 (1), 7 (4+3) (4), 8 (5), and 9-10 (15). The average PSA was 17.2 ng/mL with a range of 5.6 to 51.92 ng/mL, and average number of positive cores was 74%. These factors put the majority of patients into the very high risk group. The median follow up was 24 months. The majority of the patients tolerated treatment well. Grade 0 genitourinary (GU) toxicity occurred
in 8 (33%) patients, grade II 16 (67%) patients, one patient had a Foley catheter during treatment, a majority of patients were on alpha blockers either before, during or post radiotherapy. Grade 0 gastrointestinal (GI) toxicity occurred in 21 (84%) patients, grade 1 in one, and grade II in 3 (12%) patients. There were no grade 3 or 4 GU or GI toxicities.
Conclusions: Simultaneous integrated boost with VMAT is well tolerated in treating pelvic nodes and prostate boost, without any major acute toxicities. This technique is used in mostly for very high risk localized prostate cancer patients, reducing number of fractions from conventional sequential treatment.
Purpose: It is conventional to treat pelvic lymph nodes, followed by prostate boost in a sequential manner, requiring 8-9 weeks to complete therapy. In the last several years there have been several randomized studies of implementing moderate hypofractionated radiotherapy in prostate cancer to shorten the treatment time, which has proven to be non-inferior to conventional treatment. The purpose of this retrospective study is to evaluate the acute toxicities of hypofractionated SIB radiotherapy in treating the lymph nodes with prostate boost.
Methods: Between 2015 and 2017, twenty five high risk prostate cancer patients received pelvic node radiotherapy with prostate boost in 25 fractions with SIB technique with neo-adjuvant and concurrent hormone therapy to 50 Gy/25 fractions at 2 Gy/fraction to pelvic nodes and prostate boost for a total of 67.5 - 75 Gy at 2.7 to 3.0 Gy/fraction. We followed QUNTAC dose-volume constraints for the rectum, bladder and bowel. All these patients received long-term hormone therapy.
Results: The median age was 66 years (range 57-81 years). There were 6 stage II C, 7 III A, 15 III C, and 1 stage IV A. All patients were restaged as per American Joint Committee on Cancer 8th edition. Gleason Score: 6 (1), 7 (4+3) (4), 8 (5), and 9-10 (15). The average PSA was 17.2 ng/mL with a range of 5.6 to 51.92 ng/mL, and average number of positive cores was 74%. These factors put the majority of patients into the very high risk group. The median follow up was 24 months. The majority of the patients tolerated treatment well. Grade 0 genitourinary (GU) toxicity occurred
in 8 (33%) patients, grade II 16 (67%) patients, one patient had a Foley catheter during treatment, a majority of patients were on alpha blockers either before, during or post radiotherapy. Grade 0 gastrointestinal (GI) toxicity occurred in 21 (84%) patients, grade 1 in one, and grade II in 3 (12%) patients. There were no grade 3 or 4 GU or GI toxicities.
Conclusions: Simultaneous integrated boost with VMAT is well tolerated in treating pelvic nodes and prostate boost, without any major acute toxicities. This technique is used in mostly for very high risk localized prostate cancer patients, reducing number of fractions from conventional sequential treatment.
Purpose: It is conventional to treat pelvic lymph nodes, followed by prostate boost in a sequential manner, requiring 8-9 weeks to complete therapy. In the last several years there have been several randomized studies of implementing moderate hypofractionated radiotherapy in prostate cancer to shorten the treatment time, which has proven to be non-inferior to conventional treatment. The purpose of this retrospective study is to evaluate the acute toxicities of hypofractionated SIB radiotherapy in treating the lymph nodes with prostate boost.
Methods: Between 2015 and 2017, twenty five high risk prostate cancer patients received pelvic node radiotherapy with prostate boost in 25 fractions with SIB technique with neo-adjuvant and concurrent hormone therapy to 50 Gy/25 fractions at 2 Gy/fraction to pelvic nodes and prostate boost for a total of 67.5 - 75 Gy at 2.7 to 3.0 Gy/fraction. We followed QUNTAC dose-volume constraints for the rectum, bladder and bowel. All these patients received long-term hormone therapy.
Results: The median age was 66 years (range 57-81 years). There were 6 stage II C, 7 III A, 15 III C, and 1 stage IV A. All patients were restaged as per American Joint Committee on Cancer 8th edition. Gleason Score: 6 (1), 7 (4+3) (4), 8 (5), and 9-10 (15). The average PSA was 17.2 ng/mL with a range of 5.6 to 51.92 ng/mL, and average number of positive cores was 74%. These factors put the majority of patients into the very high risk group. The median follow up was 24 months. The majority of the patients tolerated treatment well. Grade 0 genitourinary (GU) toxicity occurred
in 8 (33%) patients, grade II 16 (67%) patients, one patient had a Foley catheter during treatment, a majority of patients were on alpha blockers either before, during or post radiotherapy. Grade 0 gastrointestinal (GI) toxicity occurred in 21 (84%) patients, grade 1 in one, and grade II in 3 (12%) patients. There were no grade 3 or 4 GU or GI toxicities.
Conclusions: Simultaneous integrated boost with VMAT is well tolerated in treating pelvic nodes and prostate boost, without any major acute toxicities. This technique is used in mostly for very high risk localized prostate cancer patients, reducing number of fractions from conventional sequential treatment.
Evaluation of Acute Toxicities of Hypofractionated Radiotherapy Using Volumetric Arc Therapy
Purpose: Traditional radiation therapy for prostate cancer is given over 39 – 42 daily fractions. There have been increasing efforts to decrease the treatment time by using hypofractionated radiotherapy. The purpose of this retrospective study is to evaluate the acute toxicities (RTOG definition) in prostate cancer patients when using hypofractionated radiotherapy.
Methods: 42 patients were treated with 25 daily fractions from 2014 – 2015. Patient, tumor, and dosimetric factors (rectal and bladder min dose, max dose, mean dose, median dose, volume, V31, V50, as well as PTV max, min, mean, and median doses) were analyzed to find associations between acute (< 90 days) GU and GI toxicities.
Results: The median age was 68 with a median follow-up of 18 months. There were 2 low, 12 intermediate, and 18 high risk patients (NCCN criteria). Dose fractionations schemas used were 267 cGy (n = 6), 270 cGy (n = 14); 275 cGy (n = 17), and some high risk patients received a simultaneous integrated boost (SIB) of 300 cGy (n = 5) to a smaller volume of the prostate. 13 patients received pelvic irradiation via SIB at 200 cGy per fraction. 10 patients received no androgen deprivation therapy (ADT), 15 received short term ADT (≤ 6 months), and 17 received long term ADT (> 6 months). Grade 0 acute GU toxicity occurred in 12 patients (29%), grade 1 in 7 (17%), grade 2 in 22 (52%), and grade 3 in 1 (2%). Grade 0 acute GI toxicity occurred in 30 patients (71%), grade 1 in 5 (12%), grade 2 in 7 (17), and no grade 3 toxicity. There were no grade 4 or 5 toxicities. On univariate analysis, factors positively associated with acute GU toxicity were AUA score (P = .02) and PTV max dose (P = .04); acute GI were pelvic radiation (P = .04) and rectal min dose (P = .02). These factors were not significant on multivariate analysis.
Conclusion: Volumetric Arc Therapy based hypofractionated radiotherapy was well tolerated and is an acceptable treatment for prostate cancer patients. Larger and adequately powered studies are needed to validate these findings.
Purpose: Traditional radiation therapy for prostate cancer is given over 39 – 42 daily fractions. There have been increasing efforts to decrease the treatment time by using hypofractionated radiotherapy. The purpose of this retrospective study is to evaluate the acute toxicities (RTOG definition) in prostate cancer patients when using hypofractionated radiotherapy.
Methods: 42 patients were treated with 25 daily fractions from 2014 – 2015. Patient, tumor, and dosimetric factors (rectal and bladder min dose, max dose, mean dose, median dose, volume, V31, V50, as well as PTV max, min, mean, and median doses) were analyzed to find associations between acute (< 90 days) GU and GI toxicities.
Results: The median age was 68 with a median follow-up of 18 months. There were 2 low, 12 intermediate, and 18 high risk patients (NCCN criteria). Dose fractionations schemas used were 267 cGy (n = 6), 270 cGy (n = 14); 275 cGy (n = 17), and some high risk patients received a simultaneous integrated boost (SIB) of 300 cGy (n = 5) to a smaller volume of the prostate. 13 patients received pelvic irradiation via SIB at 200 cGy per fraction. 10 patients received no androgen deprivation therapy (ADT), 15 received short term ADT (≤ 6 months), and 17 received long term ADT (> 6 months). Grade 0 acute GU toxicity occurred in 12 patients (29%), grade 1 in 7 (17%), grade 2 in 22 (52%), and grade 3 in 1 (2%). Grade 0 acute GI toxicity occurred in 30 patients (71%), grade 1 in 5 (12%), grade 2 in 7 (17), and no grade 3 toxicity. There were no grade 4 or 5 toxicities. On univariate analysis, factors positively associated with acute GU toxicity were AUA score (P = .02) and PTV max dose (P = .04); acute GI were pelvic radiation (P = .04) and rectal min dose (P = .02). These factors were not significant on multivariate analysis.
Conclusion: Volumetric Arc Therapy based hypofractionated radiotherapy was well tolerated and is an acceptable treatment for prostate cancer patients. Larger and adequately powered studies are needed to validate these findings.
Purpose: Traditional radiation therapy for prostate cancer is given over 39 – 42 daily fractions. There have been increasing efforts to decrease the treatment time by using hypofractionated radiotherapy. The purpose of this retrospective study is to evaluate the acute toxicities (RTOG definition) in prostate cancer patients when using hypofractionated radiotherapy.
Methods: 42 patients were treated with 25 daily fractions from 2014 – 2015. Patient, tumor, and dosimetric factors (rectal and bladder min dose, max dose, mean dose, median dose, volume, V31, V50, as well as PTV max, min, mean, and median doses) were analyzed to find associations between acute (< 90 days) GU and GI toxicities.
Results: The median age was 68 with a median follow-up of 18 months. There were 2 low, 12 intermediate, and 18 high risk patients (NCCN criteria). Dose fractionations schemas used were 267 cGy (n = 6), 270 cGy (n = 14); 275 cGy (n = 17), and some high risk patients received a simultaneous integrated boost (SIB) of 300 cGy (n = 5) to a smaller volume of the prostate. 13 patients received pelvic irradiation via SIB at 200 cGy per fraction. 10 patients received no androgen deprivation therapy (ADT), 15 received short term ADT (≤ 6 months), and 17 received long term ADT (> 6 months). Grade 0 acute GU toxicity occurred in 12 patients (29%), grade 1 in 7 (17%), grade 2 in 22 (52%), and grade 3 in 1 (2%). Grade 0 acute GI toxicity occurred in 30 patients (71%), grade 1 in 5 (12%), grade 2 in 7 (17), and no grade 3 toxicity. There were no grade 4 or 5 toxicities. On univariate analysis, factors positively associated with acute GU toxicity were AUA score (P = .02) and PTV max dose (P = .04); acute GI were pelvic radiation (P = .04) and rectal min dose (P = .02). These factors were not significant on multivariate analysis.
Conclusion: Volumetric Arc Therapy based hypofractionated radiotherapy was well tolerated and is an acceptable treatment for prostate cancer patients. Larger and adequately powered studies are needed to validate these findings.