Local, regional and pulmonary failures in the randomised PET-boost trial for NSCLC patients
De Ruysscher, D.
Persson, G. F.
Van Diessen, J.
AffiliationRadiation Oncology, The Netherlands Cancer Institute, Amsterdam/NL
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AbstractIntroduction: 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.
CitationCooke 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.
JournalJournal of Thoracic Oncology
TypeMeetings and Proceedings