patients treated with linear accelerator-based SABR between 2009 and 2016 were retrospectively studied. Impact of patient, tumor, and treatment parameters on LC, OS and toxicity-free survival (TFS) were evaluated by multivariate analyses. Result: Forty-eight PL and 22 OM lesions were analyzed, including 20 (28%) re-irradiation (Re-RT) cases. Median total, fractionated, and biological equivalent doses in BED10 and BED3 were 55 (30-60), 9.75 (4-18), 110 (41-151), and 228 (90-378) Gy, respectively. Doses given as Re-RT were lower (median Re-RT BED10 dose 94 vs. 110 Gy, P¼0.009). Complete response (CR) was obtained in 43 (61%) lesions. None of the analyzed factors correlated to CR. After a median follow-up of 57 (48-65, 95%CI) months, 10 (14%) lesions had relapsed and 37 (57%) patients had died (2 and 5year LC and OS rates were 84/70% and 52/28%, respectively). In univariate analysis, 2-year LC was lower for lesions with no CR and for colorectal cancer lesions. Only "no CR" was significant (100 vs. 51%; HR¼18.2, CI 2.3-146, P¼0.006) in final multivariate analyses. Median OS was significantly lower in patients with grade 3+ toxicity (5 months after grade 3+ toxicity, vs. 39 months in others [HR 4.7,P<0.0001]). OS was marginally lower in patients with primary lung cancer compared to patients with OM tumors (19 vs. 49 months, HR 2.3, CI 1-5.6, P¼0.06). Among 17 toxicities, 5 reached grade 5. For patients with grade 3+ toxicities, TFS was lower after Re-RT (2-year TFS 63% vs. 96%, HR 5.1, CI 1.3-20.3, P¼0.022) but did not differ significantly for lesions abutting TBT (2-year TFS 69% vs. 93.4%, HR 3.5, CI 0.9-13.9, P¼0.08). Conclusion: SABR is an effective treatment modality in centrally located lung tumors. SABR to re-irradiated lesions and possibly lesions abutting TBT may have the higher risks for serious toxicities. Further studies are indicated.
IntroductionLow dose CT screening reduced lung cancer mortality by 20% in the National Lung Screening Trial (NLST) using eligibility criteria of age 55–74 yrs, ≥30 pack year smoking history, and quit time < 15 years. The US Preventative Services Task Force (USPSTF) has proposed using the NLST criteria extending the upper age limit to 80 years. Alternative proposed eligibility criteria use thresholds from composite risk prediction scores such as a 1.51% lung cancer risk over 6 years using the PLCOM2012 model (derived from the Prostate Lung Colorectal and Ovarian Study) and a 5% lung cancer risk over 5 years using the Liverpool Lung Project (LLP) model (used in the UK Lung Screening trial). We sought to compare the proportions of patients in the UK who would be eligible for screening according to these criteria.MethodsWe commissioned an anonymous telephone survey in Yorkshire (Hull, Leeds and Wakefield) to collect parameters to calculate lung cancer risk (PLCOM2012 and LLPv.2) and likelihood of participation in a future programme. Index of multiple deprivation (IMD) was recorded based on postcode and used to ensure a representative cohort. No patient identifiable information was entered into the research database.Results2,424 persons 55–80 years agreed to participate in the telephone survey, of which 1,335 were ever-smokers. The proportion of patients (95% CI) eligible according to various criteria were as follows: NLST 11.9% (10.6%–13.2%), USPSTF 13.3% (12.0%–14.7%), PLCOM2012 ≥1.51% 20.7% (19.1%–22.3%) and LLP ≥5% 15.8% (14.4%−17.3%). The proportions eligible by USPSTF, PLCO and LLP criteria by IMD and age cohort are shown in Figure 1. When asked how likely they would be to attend an NHS lung cancer screening programme, 62.6% indicated ‘very likely’. This proportion was similar between those eligible for screening by any criteria and those not (62.5% and 62.7% respectively) and current and ex-smokers (61.4% and 63.0% respectively).DiscussionThe proportions of the population eligible for screening differ considerably between various eligibility criteria, and according to deprivation and age. The criteria selected to determine screen-eligibility in a future national screening programme will have a significant impact on the cost and cost-effectiveness of such a programme.Abstract S131 Figure 1The proportion of 55–80 year old population eligible for screening by various criteria by IMD quintile and age
The US National Lung Screening Trial (NLST) identified persons for lung cancer screening by age (55–74 yrs) and smoking history, but a subsequent analysis of the US SEER database showed that only 26.7% of lung cancer cases would have been eligible for screening according to these criteria.Strategies to increase the proportion of lung cancer patients who might qualify for screening include increasing the upper age limit to 80 years (endorsed by the US Preventative Services Task Force – USPSTF), and using composite lung cancer risk prediction tools. The UK Lung Screening pilot (UKLS) used the Liverpool Lung Project score (LLP) to identify patients for screening. In a validation cohort from the US Prostate, Lung, Colorectal and Ovarian study, a threshold based on the PLCOM2012 score identified more cancers than the NLST criteria. We prospectively compared these criteria for the first time in patients presenting with lung cancer in Yorkshire.MethodsWe audited the proportion of patients presenting with lung cancer through fast-track clinics at 4 Yorkshire centres who would have been eligible for screening according to the following criteria: NLST criteria, UKLS criteria, USPSTF criteria, LLP ≥5% 55–80 yrs, and PLCO ≥1.51% 55–80 yrs.ResultsData was collected for 206 patients presenting between January and July 2016 (Leeds 131, Halifax 26, Bradford 12, Mid-Yorkshire 37). Median age was 72 years and the proportion of cases by age cohort was as follows: <55 yrs 9.2%, 55–60 yrs 9.7%, 61–65 yrs 12.1%, 66–70 yrs 13.6%, 71–75 yrs 18.4%, 76–80 yrs 17.0%, >80 yrs 19.9%. Smoking status was: current smoker 89 (43.2%), ex-smoker 106 (51.5%) and never smoker 11 (5.3%). The number of patients eligible by the various criteria are shown in Table 1.ConclusionThe proportion of lung cancer patients who would have been eligible for screening differs considerably between the various criteria. Only approximately one third of patients would have been eligible according to the criteria used in NLST and UKLS. Increasing the upper age limit for screening to 80yrs substantially increases the proportion of cases that would be eligible. A threshold of 1.51% by the PLCOM2012 score included the largest number of lung cancer patients of the criteria assessed.Abstract S129 Table 1The numbers and proportions of lung cancer patients who would have been eligible for CT screening according to various inclusion criteriaCriteriaDescriptorNumber of eligible patientsProportion of all lung cancer patientsProportion of 55–80yrs ever-smoking patientsNLSTAge 55–74, ≥30 pack years smoking, quit time <15 years7134.5%51.1%USPSTFAge 55–80, ≥30 pack years smoking, quit time <15 years8943.2%64.0%UKLSAge 50–75, ≥5% lung cancer risk by LLPv.26732.5%48.2%PLCO ≥1.51%Age 55–80, ≥1.51% lung cancer risk by PLCOM201211153.9%79.9%LLP ≥5%Age 55–80, ≥5% lung cancer risk by LLPv.29445.6%67.6%
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