Progression-Free Interval After RFA of Lung Tumors Size Matters

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Presentation transcript:

Progression-Free Interval After RFA of Lung Tumors Size Matters 100 80 60 ≤ 3 cm Progression-Free (%) 40 P = .0002 20 > 3 cm 12 24 36 48 60 72 Months Since Radiofrequency Ablation Dupuy D. Radiofrequency ablation can destroy small lung tumors while avoiding the toxicity of thoracotomy or radiation. 42nd ASCO; June 2-6, 2006. Slide 14. Graphic courtesy of Dr. Damien Dupuy.

Radiofrequency Ablation/Radiation Therapy in NSCLC Pre-RFA 2 Weeks Post-RFA 6 Months Post-RFA/XRT RFA = radiofrequency ablation; XRT = radiation therapy. Dupuy D. Radiofrequency ablation can destroy small lung tumors while avoiding the toxicity of thoracotomy or radiation. 42nd ASCO; June 2-6, 2006. Slide 14. Graphic courtesy of Dr. Damien Dupuy.

CT Images During Cryotherapy and at Follow-Up for Treatment of Small Pulmonary Mass Before Cryotherapy After Cryotherapy Wang H, et al. Radiology. 2005;235:289-298. Copyright © Radiological Society of North America, 2005.

Stereotactic Body Radiation Therapy (SBRT) for NSCLC Graphic courtesy of Dr. Hak Choy.

Optimization of Radiation Therapy Stereotactic Body Radiation Therapy 100 100 BED ≥ 100 Gy (n = 64) ~88% 80 80 ~68% 60 60 BED < 100 Gy (n = 23) Local Tumor Control (%) Overall Survival (%) 40 40 P < .05 20 20 12 24 36 48 1 2 3 4 5 6 7 Months from Therapy Time (Years) Indiana University1 Japan2 BED = biological equivalent dose. 1. Adapted from Cancer, Vol. 101, 2004: 1623-1631. Copyright © 2004 American Cancer Society. This material is reproduced with permission of Wiley-Liss, Inc., a subsidiary of John Wiley & Sons, Inc. 2. Adapted from J Clin Oncol, 2006; 24: 4833, with permission from the American Society of Clinical Oncology.

Prophylactic Cranial Irradiation in Extensive-Disease Small-Cell Lung Cancer (EORTC 08993-22993) Study Design PCI 20–30 Gy in 5–12 Fractions Chemotherapy (4–6 Cycles) No Response Random Any response No PCI <5 Weeks 4–6 Weeks Stratification: performance score and institute Reprinted from Slotman BJ, et al. (ASCO 2007, #4; N Engl J Med. 357:664-672, 2007).

Prophylactic Cranial Irradiation in Extensive-Disease Small-Cell Lung Cancer Symptomatic Brain Metastases 100 90 1 Year: 14.6% vs 40.4% HR: 0.27 (0.16–0.44) 80 70 P < .001 60 Symptomatic Brain Metastases (%) 50 40 Control 30 20 PCI 10 4 8 12 16 20 24 28 32 36 Time Since Randomization (Months) Reprinted from Slotman BJ, et al. (ASCO 2007, #4; N Engl J Med. 357:664-672, 2007).

Prophylactic Cranial Irradiation in Extensive-Disease Small-Cell Lung Cancer Overall Survival 100 90 1 Year: 27.1% vs 13.3% HR: 0.68 (0.52–0.88) 80 70 60 Overall Survival (%) 50 P = .003 40 30 PCI 20 Control 10 4 8 12 16 20 24 28 32 36 Time Since Randomization (Months) Reprinted from Slotman BJ, et al. (ASCO 2007, #4; N Engl J Med. 357:664-672, 2007).

Phase III Trial of WBRT and SRS with Temozolomide or Erlotinib RTOG 0320 Eligibility1 NSCLC 1–3 brain metastases Max. lesion: 4 cm No brainstem metastases No actively progressing extracranial cancer x 1 month RPA Class2 1 (<65 y and no extracranial cancer vs 2 (>65 y or extracranial metastases) Number of Brain Metastases2 1 vs 2/3 Extent of Extracranial Disease2 Yes vs no RANDOMI ZE WBRT + SRS S T R A I F Y WBRT + SRS + Temozolomide WBRT + SRS + Erlotinib WBRT = whole brain radiation therapy; SRS = stereotactic radiosurgery; RPA = recursive partitioning analysis. 1. ClinicalTrials.gov Web site. http://www.clinicaltrials.gov/ct/show/NCT00096265?order=1. 2. Sperduto PW, et al. Slide 4. www.rtog.org/members/protocols/0320/0320Presentation.pdf.

Response to Chemoradiotherapy on FDG-PET Correlates with Survival 100 84% 84% 80 CR PR NR/PD 60 53% Estimated Survival (%) 40 36% P = .0033 N = 57 20 18% 3 6 9 12 15 18 21 48 Months Following PET Scan On multivariate analysis, PET response was a more significant predictor (P = .006) than Karnofsky performance status (P = .09) and weight loss (P = .14). MacManus M, et al. 36th ASCO; May 20-23, 2000. Abstract 1888; Slide 22.

Lung Cancer PET Study ACRIN 6668/RTOG 0235 Design Concurrent chemotherapy/ radiation therapy (+/- adjuvant chemotherapy per MD) P ET P ET N = 250 PET or PET-CT to be done 12–16 weeks following radiation therapy and at least 4 weeks after adjuvant chemotherapy (if given) Machtay M, et al. 2004. ACR Web site. p 3. http://www.acrin.org/files/protocol_docs/A6668partial_summary.pdf.

Impact of PET on Radiation Therapy Volumes in Lung Cancer Author N Method Impact Hebert1 20 Visual 6/20 Kiffer2 15 Visual 4/15 Nestle3 34 Visual 12/34 Munley4 35 Visual 12/35 Vanuytsel5 73 Direct 45/73 Giraud6 12 Image fusion 5/12 Bradley7 26 Image fusion 8/26 NEED TO CONFIRM GIRAUD DATA WHEN WE GET FULL PAPER 1. Hebert ME, et al. Am J Clin Oncol. 1996;19:416. 2. Kiffer JD, et al. Lung Cancer. 1998;19:167. 3. Nestle U, et al. Int J Radiat Oncol Biol Phys. 1999;44:593. 4. Munley MT, et al. Lung Cancer. 1999;23:105. 5. Vanuytsel LJ, et al. Radiother Oncol. 2000;55:317. 6. Giraud P, et al. Cancer Radiother. 2001;5:725. 7. Bradley J, et al. Int J Radiat Oncol Biol Phys. 2004;59:78.