Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent...
-
Upload
kristina-sims -
Category
Documents
-
view
230 -
download
1
Transcript of Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent...
![Page 1: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/1.jpg)
Comparison of SIB-IMRT and Conventional Accelerated Hy
per-fractionated IMRT With Concurrent Cisplatin and Etop
oside for Limited Disease SCLC
Baosheng Li M.D. Ph.D.
Shandong Cancer Hospital,
Department of Radiation Oncology
![Page 2: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/2.jpg)
Disclosure
No conflict of interests to disclosure
![Page 3: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/3.jpg)
Background
At the time of diagnosis, 30%-40% of SCLC patients present with limited disease (LD).
SCLC is characterized by a rapid doubling time,high growth fraction, and early development of widespread metastases.
Patients with disease in excess of T1-2, N0 do not benefit from surgery.
Concurrent chemoradiotherapy represents the standard treatment for patients with LD-SCLC.
![Page 4: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/4.jpg)
Background
Accelerated hyper-fractionated radiotherapy (4
5Gy with 1.5Gy twice daily in 3 weeks)
Dose-escalated conventional radiotherapy (60-70
Gy with 2Gy once daily in 6 to 7 weeks )
Concurrent chemoradiotherapy have been docu
mented as reliable schedules.
![Page 5: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/5.jpg)
RT in SCLC
53.6%±3.3% SCLC patients need RT in every stage in the disease
45.4%±4.3% SCLC patients in the initial treatment
8.2%±1.5% SCLC patients later for recurrence or progression
Local failures occur in approximately one third of patients and the outcome is still poor.
![Page 6: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/6.jpg)
RTOG 97-12
Komaki R, et al. IJROBP. 62,342-350, 2005
![Page 7: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/7.jpg)
Lg Field (1.8 Gy/Fx) Boost (1.8Gy Bid) Total Dose
x (off cord)
RTOG 97-12
Wk 1 2 3 4 5
![Page 8: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/8.jpg)
RTOG 0239
RT compliance rate: 95 %
Objective response:
CR: 41%, PR: 39%
2Y OS: 36.6 %
Severe hematopoietic toxicity was
as high as 90% ( 15 grade 3 and 49
grade 4).
![Page 9: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/9.jpg)
Protocol: 6 cycles of etoposide and cisplatin .
Cycles 4 and 5 included concurrent higher dose
TRT (30Gy/20 twice daily fractions, a 2-week b
reak, and another 30Gy/20 twice daily fractions).
NCCTG 95-20-53
Schild SE,et al. J Clin Oncol 2007, 25: 3124-3129.
![Page 10: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/10.jpg)
Results
A total of 76 assessable patients enrolled.
5-year OS rate: 24%.
The locoregional failure remained a proble
m and grade 3 or grade (3+) toxicities were
as high as 97%.
![Page 11: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/11.jpg)
Phase III trial of concurrent thoracic radiotherapy wit
h either first- or third-cycle chemotherapy for limited-d
isease small-cell lung cancer
Sun jm,et al. Ann Oncol. 2013;24(8):2088-92
![Page 12: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/12.jpg)
Results: 222 patients were randomly assigned
early TRT Late TRT P-value
CR 36% 38% >0.05
Median OS 24.1 26.8 >0.05
Median PFS 12.4 11.2 >0.05
Meutropenic fever 21.6% 10.2% 0.02
Conclusion: TRT starting in the third cycle of chemotherapy seemed to be
noninferior to early TRT, and had a more favorable profile with regard to ne
utropenic fever.
![Page 13: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/13.jpg)
Our retrospective study was to compare toxicitie
s, disease control and survival outcomes for LD-
SCLC treated with simultaneous integrated boos
t intensity-modulated radiation therapy (SIB-IM
RT) versus conventional accelerated hyper-fracti
onated radiotherapy.
Purpose
![Page 14: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/14.jpg)
METHODS
![Page 15: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/15.jpg)
Group AGroup A Group BGroup B TotalTotal PP**Number of patientsNumber of patients 4343 5757 100100 Age (years)Age (years) 0.0780.078
mediamediann
5555 5757 5656
rangerange 35-7235-72 40-7440-74 35-7435-74
ECOG PS ECOG PS 0.4600.460 0-10-1 4141 5151 9292 22 22 66 88GenderGender 0.1300.130 MM 2929 4646 7575 FF 1414 1111 2525 AJCC 7 stage AJCC 7 stage 0.9400.940 ⅠⅠ 11 11 22 ⅡⅡ 55 88 1111 ⅢⅢAA 1414 2727 3131 ⅢⅢBB 1515 2121 2929
Patient Patient CharacteristicCharacteristicss
![Page 16: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/16.jpg)
Chemotherapy
Two cycles chemotherapy before TRT with EP regi
men (etoposide 100mg/m2 day 1-5, and cisplatin 25
mg/m2 day 1-3, 21 days per cycle) were delivered.
Then adjuvant chemotherapy were administered af
ter completion of thoracic radiotherapy. Chemothera
py was administered every 3 weeks.
A total of 4-6 cycles were administered.
![Page 17: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/17.jpg)
GTV: including the residual primary tumor and involve
d lymph nodes after induction chemotherapy.
TDF: 1.9Gy/f @ 30f in 3 weeks, 5 days a week.
CTV: defined by expanding GTV with a 0.5 cm margin
and involved lymph node region.
TDF: 1.7Gy/f @ 30f in 3 weeks , 5 days a week.
PTV: defined by expanding CTV with a 0.5 cm margin.
TDF: 1.5Gy/f @ 30f in 3 weeks , 5 days a week.
SIB-IMRT protocols
![Page 18: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/18.jpg)
SIB-IMRT
![Page 19: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/19.jpg)
The targets were defined as the same as SIB-IMRT.
TDF:1.5Gy/f @ 30f in 3 weeks , 5 days a week to PTV.
Conventional Accelerated Hyper-fractionated Radiotherapy Protocols
![Page 20: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/20.jpg)
Lung : mean lung dose < 20Gy, lung V20 < 33
% ;spinal cord : Dmax≤41Gy;
Heart : mean heart dose < 30Gy , V40<46% ; Esophagus : mean esophagus dose < 34 Gy,
V35 < 50% .
Organs at risk
![Page 21: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/21.jpg)
Patients who achieved CR or nCR were ad
ministered PCI (25 Gy in 10 fractions to the en
tire brain) within 4 weeks after completion of a
ll chemotherapy.
Prophylactic cranial irradiation
![Page 22: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/22.jpg)
Results
![Page 23: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/23.jpg)
Group A Group B
mean ± SD mean ± SD P*
MLD(Gy)a 17.7 ± 10.3 14.8 ± 1.7 0.099V5(%)b 67.4 ± 9.0 66.4 ± 9.8 0.678
V15(%)b 37.8 ± 5.8 36.3 ± 7.8 0.188V20(%)b 28.7 ± 3.2 24.5 ± 4.6 0.272V25(%)b 20.8 ± 4.4 19.0 ± 3.8 0.604V30(%)b 17.1 ± 2.6 14.1 ± 2.6 1.000V35(%)b 12.6 ± 3.5 11.3 ± 2.8 0.534
Ipsilateral lungs MLD(Gy) 22.1 ± 4.1 20.9 ± 3.5 0.564
V5(%) 79.1 ± 10.7 79.1 ± 11.7 0.941V15(%) 61.1 ± 11.7 61.2 ± 10.7 0.633V20(%) 47.2 ± 11.3 45.6 ± 9.3 0.536V25(%) 37.7 ± 11.2 34.3 ± 8.8 0.472V30(%) 30.3 ± 10.0 27.7 ± 8.5 0.761V35(%) 24.1 ± 8.6 22.0 ± 10.1 0.717
Contralateral lungs MLD(Gy) 8.8 ± 2.9 8.1 ± 2.9 0.773
V5(%) 53.1 ± 13.1 55.0 ± 12.8 0.962V15(%) 18.6 ± 10.1 15.8 ± 11.6 0.748
Total lungsTotal lungs
![Page 24: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/24.jpg)
V20(%) 11.8 ± 8.8 7.3 ± 7.3 0.567
V25(%) 7.2 ± 5.5 4.5 ± 4.8 0.512
V30(%) 5.2 ± 4.6 3.3 ± 3.6 0.457
V35(%) 3.6 ± 3.4 2.2 ± 2.5 0.415
Spinal cord Dmax(Gy)e 42.7 ± 3.7 41.0 ± 1.2 0.090
Heart
Dmean(Gy)a 16.1 ± 7.3 15.0 ± 7.2 0.641
V30(%)c 23.3 ± 15.0 18.1 ± 11.4 0.253
V40(%)c 9.0 ± 5.0 6.7 ± 3.8 0.342
Esophagus
MED(Gy)a 29.0 ± 6.7 26.8 ± 5.5 0.575
V45(%)d 33.6 ± 5.3 33.0 ± 4.5 0.882
![Page 25: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/25.jpg)
Toxicity
Toxicity Grade A组 B组 Total P*
Hematologic toxicit(WBC )
≥2 38 (88%)
30 (53%)
68 (68%) <0.001
Hematologic toxicity( PLT )
≥2 9 (21%) 9 (16%) 18 (18%) 0.508
Hematologic toxicity( HB )
≥2 11 (26%)
11 (19%)
22 (22%) 0.453
Stomach/intestine ≥2 16 (37%)
12 (21%)
28 (28%) 0.075
Esophagitis ≥2 23 (53%)
26 (46%)
49 (49%) 0.435
Pneumonitis ≥2 5 (11%) 3 (5%) 8 (8%) 0.284
![Page 26: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/26.jpg)
Treatment response
Results Group A
N = 43
Group B
N = 57
P*
0.953
Response
Complete response 22 (51%) 28 (49%)
Partical response 16 (37%) 20 (36%)
Near complete response 5 (11%) 5 (8%)
Total 38 (88%) 48 (85%)
Stable disease 4 (9%) 6 (10%)
Progressive disease 1 (3%) 3 (5%)
![Page 27: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/27.jpg)
SurvivalOutcome measure Group A Group B P*
Overall survival 0.165
Median duration 32months 28months
2 Years 70.2% 55.2%
3 Years 46.3% 36.2%
Progression-free survival 0.077
Median duration 22.5months 15.5monts
2 Years 45.7% 35.9%
3 Years 30.1% 18.6%
Locoregional recurrence-free survival 0.093
Median duration 31.5months 23monts
2 Years 67.3% 46.8%
3 Years 34.9% 26.3%
![Page 28: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/28.jpg)
OS
P = 0.165
![Page 29: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/29.jpg)
PFS
P = 0.077
![Page 30: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/30.jpg)
LRFS
P = 0.093
![Page 31: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/31.jpg)
Conclusions
Comparing with conventional accelerated hyper-
fractionated RT, SIB-IMRT for limited Disease S
CLC was feasible and had the potency of
improving local regional recurrence. However, the
toxicity was still higher.
![Page 32: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/32.jpg)
Acknowledgements
• Dr. Dan Han
• Dr. Tao Zhou
• Dr. Zhongtang Wang
• Dr. Hongsheng Li
• Prof. Yong Yin
• Associate Prof. Jian zhu
![Page 33: Comparison of SIB-IMRT and Conventional Accelerated Hyper-fractionated IMRT With Concurrent Cisplatin and Etoposide for Limited Disease SCLC Baosheng Li.](https://reader033.fdocuments.in/reader033/viewer/2022042603/56649f1d5503460f94c33bb9/html5/thumbnails/33.jpg)
Thank you !