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Vienna, Austria

ESTRO 2023

Session Item

Monday
May 15
16:30 - 17:30
Business Suite 1-2
Lung 2
Cécile Le Péchoux, France
Poster Discussion
Clinical
Postoperative IMRT Radiotherapy in resected NSCLC patients: a multicentre retrospective analysis
Valerio Nardone, Italy
PD-0961

Abstract

Postoperative IMRT Radiotherapy in resected NSCLC patients: a multicentre retrospective analysis
Authors:

Valerio Nardone1, Alessio Bruni2, Davide Franceschini3, Stefano Vagge4, Matteo Sepulcri5, Anna Cappelli6, Elisa D'Angelo7, Giuseppina De Marco8, Antonio Angrisani1, Mattia Manetta9, Melissa Scricciolo10, Cesare Guida11, Dario Aiello12, Ivan Fazio13, Paolo Borghetti9, Salvatore Cappabianca1

1University of Campania "L. Vanvitelli", Department of Precision Medicine, Naples, Italy; 2Radiotherapy Unit, University Hospital of Modena, Department of Oncology and Hematology, Modena, Italy; 3Unit of Radiotherapy, IRCCS Humanitas Research Hospital, Department of Radiotherapy and Radiosurgery, Milan, Italy; 4Radiation Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; 5Radiation Oncology Unit, Veneto Institute of Oncology IOV , Padua, Italy; 6Radiotherapy Unit, University Hospital of Modena , Modena, Italy; 7Radiotherapy Unit, University Hospital of Modena, Department of Oncology and Hematology, Modena, Italy; 8Unit of Radiotherapy, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy; 9ASST Spedali Civili and University of Brescia, Radiation Oncology Department, Brescia, Italy; 10Azienda ULSS 3 Venezia , UOC Radioterapia Oncologica, Venezia, Italy; 11Ospedale del Mare, ASL Napoli 1 Centro, Radiotherapy Unit, Naples, Italy; 12Casa di Cura Macchiarella, Radiation Oncology, Palermo, Italy; 13Casa di Cura Macchiarellla, Radiation Oncology, Palermo, Italy

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Purpose or Objective

Recently, LUNG-ART and J-PORT trial, both assessing the role of postoperative radiation therapy (PORT), have greatly changed the landscape of pN2 patients NSCLC patients undergoing surgery. In this scenario, the Italian Association of Radiotherapy and Oncology Lung Cancer study group has planned an observational multicenter trial aimed at evaluating toxicities of PORT in patients treated with modern techniques.

Material and Methods

All  acute and late toxicities (particularly cardiac, pulmonary and oesophageal) of  PORT were retrospectively reported, analyzed and then related to clinical and dosimetric parameters.  
Collaterally, regional control, distant metastasis free survival and overall survival have been analyzed using Kaplan Meyer survival curves (significant when p < 0,05).

Results

Two hundred and twelve patients from 6 different centers have been included in the present analysis (142 males and 70 females, median age 68 years).
One hundred-forty seven patients showed acute toxicity (69,3%), of whom 91 patients developed lung acute side effects (G1-G2 in 87 patients, G3 in 4 patients), 113 esophageal (G1-G2 in 112 patients, G3 in 1 patients) and finally only 4 cardiac (G1 in 2 and G3 in 2 patients). Sixty patients showed at least one late side effect (28,3%), mostly lung (43 patients G1-G2 and 1 G3) and esophageal (11 patients, all G1-G2); no late heart toxicity was reported.
An history of heart disease was found to be significantly correlated with both pulmonary acute (p:0,016) and late toxicity (p:0,008). A correlation with dosimetric parameters was found between V30-Lung and late lung toxicity (p:0,007, cut-off V30-bil>15%) and between V5-Heart and acute cardiac one (p:0,043, cut-off V5>32%).
With a median follow up of 54 months, 48 patients (22,6%) showed a locoregional relapse, while 106 patients (50%) developed distant metastases. Finally, 64 patients (30,2%) showed no evidence of disease and 55 patients (25,9%) were dead for disease.
The number of positive nodes (p:0,015) was the only parameter correlated with distant metastases, while the total number of removed nodes (p:0,034) was related with locoregional relapse.

Conclusion

RAC-TAC retrospective study confirmed the low incidence of severe toxicities after PORT when delivered with more advanced technologies. At the same time, most of the patients develop distant metastases. The total number of removed nodes and the number of positive ones e significantly correlated with the pattern of recurrence.