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Aims Choosing the optimal palliative lung radiotherapy regimen is challenging. Guidance from The Royal College of Radiologists recommends treatment stratification based on performance status, but evidence suggests that higher radiotherapy doses may be associated with survival benefits. The aim of this study was to investigate the effects of fractionation regimen and additional factors on the survival of palliative lung cancer radiotherapy patients. Materials and methods A retrospective univariable (n = 925) and multivariable (n = 422) survival analysis of the prognostic significance of baseline patient characteristics and treatment prescription was carried out on patients with non-small cell and small cell lung cancer treated with palliative lung radiotherapy. The covariates investigated included: gender, age, performance status, histology, comorbidities, stage, tumour location, tumour side, smoking status, pack year history, primary radiotherapy technique and fractionation scheme. The overall mortality rate at 30 and 90 days of treatment was calculated. Results Univariable analysis revealed that performance status (P Conclusion In this retrospective single-centre analysis of palliative lung radiotherapy, increased total dose (up to and including 30 Gy/10 fractions) was associated with better survival regardless of performance status.

Outcomes of non-small cell lung cancer (NSCLC) patients with chronic obstructive pulmonary disease (COPD n = 587) and interstitial lung disease (ILD n = 34) treated with curative-intent radiotherapy were retrospectively investigated. Presence of ILD but not decreased forced expiratory volume in 1-second correlated with poor overall survival. Increased breathlessness and oxygen requirements after radiotherapy were observed in severe/very severe COPD and ILD.

Highlights • 104 eligible lung cancer patients were approached, 86 (83%) consented to take part. • At 1st attempt 69% of patients completed the ePRO questionnaire without assistance. • Assistance was defined as verbal/physical help to complete the ePRO questionnaire. • Most patients requiring help had a companion that could have provided assistance. • More patients preferred electronic than paper questionnaires., Background Treatment related toxicity is common after chemotherapy and radiotherapy. Our group has developed and validated an electronic Patient Reported Outcome questionnaire (ePRO) to assess symptoms and toxicity in lung cancer patients receiving (chemo)radiotherapy treatment. We assessed the need for volunteer support in clinics to assist patients in completing ePROs. Methods Lung Cancer patients attending outpatient or radiotherapy clinics at The Christie NHS Foundation Trust, Manchester were consented and asked to complete a Patient Reported Outcomes questionnaire using an electronic device (a touchscreen). Trained volunteers were available if patients required help such as verbal or physical assistance. The primary objective was to determine the need for volunteers to assist lung cancer patients in completing ePROs. Results 27/86 (31.4%) of patients who consented to this study required assistance to complete the ePRO. After questioning, we found that only 7/86 (8.1%) would have relied on volunteers for assistance as the majority of patients had a companion that could have provided help. 81/86 (94.2%) of patients were satisfied with the use of a touchscreen tablet to complete the ePRO. Conclusion Our results demonstrate that the introduction of ePROs in lung cancer outpatient clinics is feasible, even without the use of volunteers for the majority of patients. The implementation of ePROs would allow large volumes of high quality (chemo)radiotherapy toxicity data to be collected accurately and quickly. This is essential for the development of predictive models of outcome using population-based data, which could allow the personalisation of (chemo)radiotherapy treatment for lung cancer patients.

Aims Recently, a survival advantage has been shown using adjuvant chemoradiotherapy after complete resection of gastric cancer. If survival advantages are to be maintained, treatment-related complications must be minimised. In this study, we explored the dosimetric implications and toxicity of conventional large field gastric bed irradiation. Materials and methods Between 2000 and 2002, 16 patients received adjuvant 5-fluorouracil (5-FU) chemoradiotherapy after complete resection of gastric cancer. Radiotherapy was simulator planned using anterior–posterior parallel opposed fields to 45Gy in 25 daily fractions over 5 weeks. Results Thirteen patients (81%) completed radiotherapy and eight patients (50%) completed chemotherapy as planned. Toxicity was the main factor for discontinuation. Substantial dose inhomogeneities were shown using retrospective computed tomography recreation of dose–volume histograms (DVHs) of the organs at risk. Conclusions Although the delivery of chemoradiotherapy using conventional two-dimensional simulator planning is a feasible technique, significant under-appreciation of dose inhomogeneity exists. Conformal computed tomography planning is vital to document doses received by organs at risk, especially the spinal cord and kidneys, which may receive high doses, and prospectively correlate these with acute and long-term toxicity in order to redefine organ at risk tolerances in the setting of chemoradiation.

Background. The benefit of dose-escalated hypofractionated radiotherapy using intensity-modulated radiotherapy (IMRT) in prostate cancer is not established. We report 5-year outcome and long-term toxicity data within a phase II clinical trial.Materials and Methods. 60 men with predominantly high-risk prostate cancer were treated. All patients received neoadjuvant hormone therapy, completing up to 6 months in total. Thirty patients were treated with 57 Gy in 19 fractions and 30 patients with 60 Gy in 20 fractions. Acute and 2-year toxicities were reported and patients followed longitudinally to assess 5 year outcomes and long-term toxicity. Toxicity was measured using RTOG criteria and LENT/SOMA questionnaire.Results. Median followup was 84 months. Five-year overall survival (OS) was 83% and biochemical progression-free survival (bPFS) was 50% for 57 Gy. Five-year OS was 75% and bPFS 58% for 60 Gy. At 7 years, toxicity by RTOG criteria was acceptable with no grade 3 or above toxicity. Compared with baseline, there was no significant change in urinary symptoms at 2 or 7 years. Bowel symptoms were stable between 2 and 7 years. All patients continued to have significant sexual dysfunction.Conclusion. In high-risk prostate cancer, dose-escalated hypofractionated radiotherapy using IMRT results in encouraging outcomes and acceptable late toxicity.

Purpose Dose escalation for prostate cancer improves biological control but with a significant increase in late toxicity. Recent estimates of low α/β ratio for prostate cancer suggest that hypofractionation may result in biological advantage. Intensity-modulated radiotherapy (IMRT) should enable dose escalation to the prostate while reducing toxicity to local organs. We report late toxicity data of a hypofractionated IMRT regime. Methods and Materials Eligible men had T2–3N0M0 adenocarcinoma prostate, and either Gleason score ≥ 7 or prostate-specific antigen 20–50 ng/L. Patients received 57–60 Gy to prostate in 19–20 fractions using five-field IMRT. All received hormonal therapy for 3 months before radiotherapy to a maximum of 6 months. Toxicity was assessed 2 years postradiotherapy using the RTOG criteria, LENT/SOMA, and UCLA prostate index assessment tools. Results Acute toxicity was favorable with no RTOG Grade 3 or 4 toxicity. At 2 years, there was 4% Grade 2 bowel and 4.25% Grade 2 bladder toxicity. There was no Grade 3 or 4 bowel toxicity; one patient developed Grade 3 bladder toxicity. UCLA data showed a slight improvement in urinary function at 2 years compared with pretreatment. LENT/SOMA assessments demonstrated general worsening of bowel function at 2 years. Patients receiving 60 Gy were more likely to develop problems with bowel function than those receiving 57 Gy. Conclusions These data demonstrate that hypofractionated radiotherapy using IMRT for prostate cancer is well tolerated with minimal late toxicity at 2 years posttreatment. Ongoing studies are looking at the efficacy of hypofractionated regimes with respect to biological control.

167 Thoracic radiotherapy in extensive stage small cell lung cancer M.A. Harris1 *, P. Holland2, R. Hogley2, P.A. Burt3, C. Faivre-Finn3, N. Bayman3, L. Pemberton3, L.W. Lee3, J.H. Coote3, H.Y. Sheikh3, A.Z. Chittalia4, F. Blackhall5, R. Califano5, Y. Summers5, P. Taylor5. 1Clinical Oncology, The Christie Hospital, Manchester, United Kingdom, 2Medical School, Manchester University, Manchester, United Kingdom, 3Department of Radiation Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom, 4Medicine, University of Manchester, Manchester, United Kingdom, 5Medical Oncology, The Christie Hospital, Manchester, United Kingdom

Aim: Themajority of advanced NSCLC patients (pts) are ≥70 years old. International guidelines recommend use of single agent chemotherapy or, for fit patients with good organ function, platinum-based doublets. This patient group is under-represented in clinical trials and undertreated in clinical practice. Methods: We retrospectively analysed all consecutive pts with advanced NSCLC and ≥70 yo treated at The Christie, Manchester, UK and San Luigi Hospital, Turin, Italy between January 2007 and December 2012. Data retrieved: demographics, performance status (PS), type of treatment, lines of treatment, response rate (RR) and date of progression/death. Primary outcome: percentage (%) of pts receiving systemic anticancer treatment (SACT). Secondary outcomes: % receiving palliative RT or best supportive care (BSC) only, % of pts stopping treatment due to toxicity, RR from first-line systemic ant-cancer therapy (SACT) and median overall survival (OS) calculated with Kaplan-Meier curves. Results: 623 pts were identified. Median age was 75 (range 70-93), 63.4% were male. PS was 0, 1, 2, 3, 4 and unknown in 20.9%, 26.3%, 30%, 20.7%, 1.9% and 0.2% of pts, respectively. Histology: Adenocarcinoma/Squamous/Bronchialveolar carcinoma/NOS: 34.7%/34.2%/26.5%/0.8%/3.8%. 3% of all pts (11% of tested non-squamous) were EGFR mutant. Treatment given: SACT (37%), palliative RT (45%) and BSC (18%). First-line SACT: single agent gemcitabine, vinorelbine, carboplatin, etoposide, pemetrexed and docetaxel (17.8%), platinum based-doublet 76.5%; (carboplatin-based 69.1%, cisplatin-based 7.4%) and gefitinib/erlotinib (EGFR-TKI) (5.7%). Treatment was stopped due to toxicity in 7.9% of pts (all had chemotherapy). Response rate to first-line: PR 9.8%, SD 20%. Second-line and third-line treatment were given to 9.8% and 3% of patients, respectively. Median OS was 10.4, 6.7, 17.8, 4.7 and 2.3 months for doublet chemotherapy, single agent chemotherapy, EGFR-TKI, palliative radiotherapy and BSC, respectively. Conclusions: In our series, 37% of pts received SACT with good tolerability. OS was in keeping with reported series unselected with regards to age; highlighting that fit elderly pts can tolerate and benefit from SACT. Disclosure: All authors have declared no conflicts of interest.

Methods: Patients with non-small cell lung cancer treated with 36Gy in 12 fractions over the last 2 and half years were identified via the Varian patient manager treatment system. Demographic, histopathological, clinical and toxicity data were collected from patient records and hospital IT systems. Data were anonymised and analysed by the authors. Results: The total number (N) of patients available for analysis was 56. The results are summarised in the table. The median age of patients at the start of treatment was 70 years (range 37 85 years). Post-radiotherapy haemoptysis was reported in 3 patients (5.1%). No patient developed myelopathy. The commonest described toxicity was dysphagia, but only 3 (6.9%) developed grade 3 dysphagia. Most patients were treated with radiotherapy via an AP-PA parallel opposed pair, median field size was 120.96 cm2 (range 75.5 209.33 cm2), consistent with the comparator where field size did not normally exceed 200 cm2. Conclusions: High dose palliative radiotherapy in Oxford University’s NHS Trust is safe and tolerable with no radiation induced myelopathy. The main toxicity of dysphagia is generally non-severe. The median survival of patients is comparable to the 9 month survival seen in the 13 fraction arm of the MRC Trial, indicating a genuine application to everyday radiotherapy practice.