P2.08-003 An Audit of Concurrent Chemoradiotherapy for Non-Small Cell Lung Cancer at the Leeds Cancer Centre (LCC)

Abstract

Concurrent chemoradiotherapy is the standard non-surgical management of locally advanced NSCLC. Radiation pneumonitis is a well-recognized complication of lung radiotherapy. This retrospective study examines the clinical outcomes and treatment toxicities of patients treated with chemoradiotherapy (CRT) for NSCLC in 2014 at the LCC in UK. Data was retrospectively collected from patients with locally advanced NSCLC treated with concurrent CRT from 1/1/14-31/12/14 at LCC. Patients received 3-D conformal radiotherapy to a dose of 60-66Gy/30-33# over 6-6.5 weeks. Individual patient’s clinical data was reviewed on Patient Pathway Manager for tumor and patient demographics. Radiotherapy dosimetric data were studied with V20, mean lung dose (MLD) and PTV volume. Treatment associated hematological toxicities and radiation pneumonitis were analyzed. Overall and progression free survival were calculated. In addition, correlations between clinical/dosimetry parameter and clinical diagnosis of radiation pneumonitis were analyzed. 58 patients were included in the study. Median follow up was 18.6 months. 66% of patients received weekly carboplatin/paclitaxel and the rest received 3 weekly cisplatin or carboplatin with etoposide. 78% of patients completed both chemotherapy and radiotherapy. For all radiotherapy plans, median V20 was 20.9Gy (range 3.4-29.8Gy), median MLD was 12.8Gy (range 2.3-16.5Gy) and median PTV was 395cc (range 73-819cc). 34% of patients developed grade 3-4 neutropenia, 64% grade 3-4 lymphopenia and 5% grade 3-4 thrombocytopenia. Neutropenic sepsis occurred in 10% of patients with one grade 5 toxicity. Radiation pneumonitis was diagnosed in 17% of patients, all below grade 3. Median time to pneumonitis was 133 days post radiotherapy. Radiation pneumonitis correlated strongly with V20(r = 0.93). Correlations with MLD and PTV were less. There were no correlations with neutropenia, lymphopenia or thrombocytopenia during treatment. 2/3 of the recurrences were distant metastases. 90 day mortality was 5% (three patients died from oesophageal perforation, colitis and pneumonia). The median progression free survival was 20.1 months. The median overall survival was not reached. At the LCC, chemoradiotherapy has been a safe and effective treatment for locally advanced lung cancer. Consistent with existing evidence, V20 remains the most powerful predictor of radiation pneumonitis following lung radiotherapy.