Loading...
Local, regional and pulmonary failures in the randomised PET-boost trial for NSCLC patients
Cooke, S. De Ruysscher, D Reymen, B. Lambrecht, M. Persson, G. F. Faivre-Finn, Corinne Dieleman, E. Van Diessen, J. Sikorska, K. Lalezari, F.
Cooke, S.
De Ruysscher, D
Reymen, B.
Lambrecht, M.
Persson, G. F.
Faivre-Finn, Corinne
Dieleman, E.
Van Diessen, J.
Sikorska, K.
Lalezari, F.
Citations
Altmetric:
Abstract
Introduction: In the phase II PET-Boost trial (NCT01024829), patients
with stage II-III non-small cell lung cancer (NSCLC) were
treated with hypofractionated dose escalation to either the primary
tumour (PT) as a whole (armA) or the high FDG-uptake region inside
the PT (>50%SUVmax) (armB). Results on Freedom From Local Failure
at 1-year (primary endpoint), and overall survival (a secondary
endpoint) were reported previously (Cooke et al,ESTRO,2020). Here
we report on local and regional failure. Methods: Patients with stage
II-III NSCLC were randomised to armA or armB, after a treatment
plan was made for both arms that were normalized to the mean lung
dose. Concurrent/ sequential/no chemotherapy was allowed. Followup
chest CT-scans - scheduled at 3/6/12/18 months - were centrally
reviewed by a thoracic radiologist. Definitions: local failure (LF):
20% growth of PT. Regional failure (RF): lymph node (LN) failure
either in-field (IF) or out-of-field (OF) on CT-scan. Kaplan Meier
analysis was performed to assess LF and RF rates at 2 years. Analysis
of distant metastases is on-going. Results: Between April 2010 and
Sep 2017, 107 patients were randomised. 82% had stage III disease
and 80% had N 1 disease. Most patients received concurrent-chemoradiotherapy
(72%). In arms A and B, median GTV-PT was 100
and 115cm3, median GTV-LN was 18 and 20cm3, median fraction
dose was 3.25Gy to PTVwhole PT and 3.50Gy to PTV50%SUVmax,
resulting in total planned physical dose 78.0 and 84.0 Gy, in 24
fractions (median OTT 34 days in both arms). Median follow-up for
CT-scans in central review was 12.6months. In armsA and B
respectively, loco-regional failure occurred in 12 and 15 patients, of
which 2 and 4 had LF-without-RF, while 9 and 10 had RF-without-
LF. One patient in armA had LF with synchronous RF, while in armB
one patient had non-synchronous LF and RF. Analysis of all RF’s (10 and 11 total) showed 3 and 4 IF, 3 and 5 OF, 3 and 0 IF as well as
OF (missing n¼3). In arms A and B respectively, the 2-year cumulative
incidence of LF was 11% and 18%, and for RF 28% and 25% Conclusion: In this randomised, phase II trial dose escalation to the
whole PT or 50%SUVmax in NSCLC patients led to excellent local control
rates in both treatment arms. The 2-year local failure rate was below
20% and regional failures rate about 27%. In future trials, dose escalation
on the PT, sparing central structures as much as possible, may be
considered.
Description
Date
2021
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Cooke S, De Ruysscher D, Reymen B, Lambrecht M, Fredberg Persson G, Faivre-Finn C, et al. OA02.05 Local, Regional and Pulmonary Failures in the Randomised PET-Boost Trial for NSCLC Patients. Journal of Thoracic Oncology. 2021 Mar;16(3):S105.