5. Body Radiosurgery | ScienceGate

7556 Background: The optimal treatment for medically inoperable stage I NSCLC has not been defined. Methods: CALGB 39904 is a prospective phase I study assessing accelerated once-daily radiotherapy for early stage NSCLC. The primary objectives were to define the maximally accelerated course of conformal radiotherapy; and to describe the short-term and long-term toxicity of therapy. Entry was limited to patients with clinical stage T1N0 and T2N0 NSCLC (< 4 cm) with pulmonary dysfunction (FEV1 <40% predicted, DLCO 45mmHg, V02 max <15m1/kg/min, O2 requirement). The nominal total radiotherapy dose was held constant at 70 Gy, while the number of daily fractions in each successive cohort was reduced (table). Results: The study was activated on 12/15/2000, and closed on 7/29/2005. Forty patients were accrued with 8 on each cohort. One patient on cohort 5 declined protocol treatment leaving 39 eligible patients. Patients were generally female (53%), white (83%), and ECOG performance status = 1 (67%). The median age was 74 (range 48 to 87), and the majority of the patients (73%) had T1N0M0 disease. Treatment was well tolerated without grade 4+ toxicity. There was one hematologic toxicity (lymphopenia) in cohort 2, and one non-hematologic toxicity each in cohort 3 (dyspnea) and cohort 4 (pain).The major repsonse rate was 74% (31% complete response, 43 % partial response), and 26% of patients had stable disease. After a median follow-up of 38.1 months, 21 patients remain alive. The actuarial median survival of all eligible patients is 38.5 months (95% confidence interval= 19.45 to NE). Conclusion: Accelerated conformal radiotherapy was well tolerated in a high-risk population with clinical stage I NSCLC. Outcomes are comparable to prospective reports of alternative therapies, including stereotactic body radiosurgery and limited resection,with less apparent severe toxicity. Further investigation of this approach is warranted. No significant financial relationships to disclose. [Table: see text]

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Pancreaticoduodenectomy versus radiosurgery for octogenarians with pancreatic head adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.220 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 220-220

Author(s):

Melissa Ellen Hogg ◽

Carolyn H Kim ◽

Brian A. Boone ◽

Kenneth K Lee ◽

Arthur J. Moser ◽

...

Keyword(s):

Karnofsky Performance Status ◽

Performance Status ◽

Skilled Nursing Facility ◽

Pancreatic Head ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Skilled Nursing ◽

R1 Resection ◽

Small Series ◽

Body Radiosurgery

220 Background: Recent reports have justified pancreaticoduodenectomy (PD) in octogenarians. Given the morbidity of PD and the increasing availability of stereotactic body radiosurgery (SBRT) we compared survival and morbidity of PD vs SBRT in octogenarians. Methods: A retrospective chart review was performed on all octogenarians with pancreatic head adenocarcinoma (PDA) who underwent open PD or SBRT from 2002-2011. Results: Twenty-six patients underwent PD, 17 (65%) resectable and 9 (35%) borderline, and 14 patients underwent SBRT, 10 (71%) resectable and 4 (29%) borderline (p=NS). All PD pts underwent R0/R1 resection. The groups differed in mean age (PD=83 vs SBRT=86 years, p=.01) and sex [males: PD=16 (62%) vs. SBRT=4 (29%)], but had the same BMI, Charlson Comorbidity Index, Karnofsky Performance Status, tumor size, and nodal status (p=NS). Of the SBRT group, 8 (57%) refused surgery; females were more likely to refuse surgery than males (8 (80%) vs 0, p=.0063). Compared to PD, SBRT patients took longer to intervention (26 vs 68 days, p=.0001). Twelve (46%) PD and 5 (36%) SBRT patients received chemotherapy (p=NS).Compared to the PD group, SBRT patients had no treatment related 90 day mortalities (0 vs 2 (8%), p=0.29), no complications (0 vs 14 (54%), p=.0007), and reduced length of hospital stay (0 vs 18.5 days, p=.0001). PD complications included pancreatic fistula and delayed gastric emptying in 3 (12%) and 4 (15%) patients respectively, and disposition was home=8 (31%), rehab=12 (46%), Skilled Nursing Facility =5 (19%), and Long Term Acute Care 1=(4%). Median time to metastasis was similar (PD=8.7 vs SBRT=7.3 months, p=NS). Median overall survival (PD=10.4 vs SBRT=10.2, p=NS) was the same in both groups. Four (15%) PD patients, stage II, are still alive (42-58 months); however, no SBRT patients are alive or have survived greater than 17 months. Conclusions: Octogenarians tolerated SBRT without morbidity, mortality, admission, or loss of independence compared to PD. Within this small series, disease specific survival and disease progression were not different between SBRT and PD raising a provocative question when counseling octogenarians about treatment strategy for head PDA.

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