41 / 154
A B S T R A C T S
S11
(often on a daily basis) just before radiotherapy is delivered
to allow positional correction if necessary so that the dose is
correctly delivered to the target. This can be achieved with CT
imaging or by implanting radio-opaque seeds, which allows
the target to be identified using treatment x rays. This assures
accurate treatment of the tumour and potentially allows
smaller safety margins to be used, thereby sparing healthy
tissue.
Stereotactic radiotherapy (SRT):
SRT involves highly
targeted treatment. It has been used for many years to treat
a variety of brain lesions, using traditional fractionations
such as 60 Gy in 30 fractions. More recently it has been used
to treat small discrete lesions in a limited number (one to
five) of higher dose fractions Stereotactic radiosurgery refers
to SRT delivered in just one session. Stereotactic ablative
radiotherapy (SABR), also known as stereotactic body
radiotherapy, refers to precise irradiation of extracranial
lesions. As a result of improvements in image guidance, it is
now increasingly offered for sites including the lung, prostate,
liver, and pancreas
Protonbeamtherapy:
Protonbeamtherapy isanestablished
technology that uses protons rather than photons to deliver
the radiation dose. The physical properties of protons enable
the dose to be deposited up to, but not beyond, a specific
depth within tissue. When compared with photons, this
limited range allows improved target volume coverage, with
reduced doses to the normal tissue beyond. This is expected
to reduce the risks of late effects, including second cancers
and cardiovascular risk, which are particularly relevant when
treating children and young adults.
The future of radiotherapy:
The evolution of radiotherapy
will continue, fuelled by improvements in imaging, computing,
and engineering, combined with a greater understanding of
tumour biology. Ensuring the availability of newly established
techniques to patients who would benefit from them poses
an important challenge, particularly in the face of economic
constraints. It is hoped that more precise delivery of
radiotherapy coupled with strategies to enhance tumour cell
killing, such as chemoradiation, will enable more cancers to
be cured with fewer side effects.
Global treatment time can also be shortened favoring those
patients facing logistical and socio-economic difficulties
(access to radiotherapy services, for example): several studies
support “hypofractionated regimens”, rapid treatment
schemes with higher daily doses and shorter total treatment
time, as a viable alternative to conventional radiotherapy,
generally delivered in 5–7 weeks.
Disclosure of interest:
None declared
S32
FUTURE STRATEGIES AND COLLABORATIONS
Andrea Luciani
Ospedale S. Paolo, Medical Oncology, Milan, Italy
The speaker abstract has not been received at the time of
publication.
S33
CGA IN ADVANCED LUNG CANCER: WHAT HAVE WE
LEARNED AND WHAT IS NEXT? NON-SMALL-CELL LUNG
CANCER
Andrea Luciani
Ospedale S. Paolo, Medical Oncology, Milan, Italy
Lung cancer is the leading cause of cancer death in most
countries. Non-small-cell lung cancer (NSCLC) accounts for
80% to 85% of lung cancer. The median age at the diagnosis
is 70 and less than 5% of patients are under 50 years old. A
recent evidence of more than 1500 patients with lung cancer
showed that the prognosis of patients 40 years or younger
with metastatic disease is no better than that of patients
older than 70 years, whereas patients in other age categories
have improved prognosis compared with the oldest age
group. As most patients with NSCLC are detected with locally
advanced or metastatic disease they have a poor survival.
In the metastatic setting guideline recommend, for patients
with performance status (PS) of 0 or 1, a combination of two
cytotoxic drugs with a preference of platinum combinations
over non-platinum therapy. Elderly patients are candidates
for monotherapy. However, in a clinical trial Carboplatin +
Taxol is superior to monotherapy in older people in terms
of overall survival and progression free survival but with a
worse toxicity profile. As most of lung cancer patients are
smokers or past smokers carrying with them some relevant
cardiovascular and respiratory comorbidities, they represent a
difficult population to be treated properly.The use of a geriatric
assessment (CGA) is mandatory and has a pivotal role for
risk assessment and tailoring treatment. It gives an estimate
of the residual life expectancy and evaluates the weight of
comorbidities, the social conditions and nutritional status.
Early evidence showed that baseline IADLs impairment are
predictive of overall survival in advanced non-small cell lung
cancer. The main challenge in older patients with advanced
non-small cell lung cancer is to balance the risk and the
benefit of a cancer treatment. The border between the benefit
and the harm in these patients is thin and PS alone cannot be
exhaustive. Frequently fit patients are undertreated even if the
evidence of the beneficial effect of palliative chemotherapy is
well known. Equally, unfit patients are generally over treated
with unacceptable toxicities, treatment related mortality and
use of resources. In a recent randomized trial a CGA-guided
approach seems to minimize undertreatment, by increasing
the percentage of patients who received standard-of-care
combination chemotherapy, as well as overtreatment, by
identifying patients who may be more appropriate for best
supportive care. Even if CGA-guided approach is not superior
to the standard approach, it demonstrated less toxicity.
The French group analyzed the impact of Quality of life at
the diagnosis and found that it seems to be an important
prognostic factor for overall survival.
Last and not least, the clinicians should consider early
palliative care support for these patients as it has demon-
strated to improve overall survival when considered at the
beginning of clinical course in advanced disease.
Small-cell lung cancer (SCLC) is a highly aggressive as well
as mortal disease both in younger and older patients. A recent