S54 Poster abstracts, 12th Annual British Thoracic Oncology Group Conference, 2014: Radiotherapy

and, in patients with a single brain metastasis, improve overallsurvival. Bristol Haematology and Oncology Centre (BHOC) havebeen using stereotactic radiotherapy (SRS) to treat patients withbrain metastasis since 2003. These are the results of our experiencein patients with non-small cell lung cancer.Method: An electronic database identified patients treated by SRSwith brain metastases from NSCLC. All patients treated at the BHOCwere included (08/12/2003 to 01/09/2013). Data was collectedretrospectively on the use of WBRT, control of the brain metastasisand survival from treatment.Results: Details were collected on 26 patients ranging in agebetween 50 and 70 years (median 62). 50% were male and 25 had asingle metastasis treated. Where documented, performance statuswas 0 1. Median survival was 377.5 days, with a range of 40 daysto more than 785 days. 23% of patients survive at this time;88% survived more than 6 months; 54% have survived beyond 1 year.23% of patients had documentation of CNS progression. 46% receivedWBRT: 33% prior to SRS and 66% subsequent to SRS.Conclusion: This small series suggests NSCLC patients, with a singlebrain metastasis and good performance score, treated with SRS canachieve good local control with over half of patients living beyonda year.

147 Sequential chemotherapy and continuoushyperfractionated accelerated radiotherapy (CHART) fornon-small cell lung cancer (NSCLC): experience from nineUK centres

A.G. Bradshaw1 *, J.E. Lester1, T. Das1, C. Esler2, J. Branagan2,A.E.F. Roy3, E.W. Toy4, A. Alip4, J.F. Lester5, R. Williams5,J. Kinsman6, C. Comins6, P. Atherton7, C. Knox8, S. Morgan8,G.A. Walker9, M.Q. Hatton1. 1Weston Park Hospital, Sheffield,UK, 2University Hospitals of Leicester NHS Trust, Leicester, UK,3Plymouth Hospitals NHS Trust, Derriford Road, Plymouth, UK,4Royal Devon and Exeter NHS Foundation Trust, Barrack Road,Exeter, UK, 5Velindre Cancer Centre, Velindre Road, Cardiff, UK,6University Hospitals Bristol NHS Trust, Bristol, UK, 7Newcastleon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle,UK, 8Nottingham University Hospitals NHS Trust, City Hospital,Nottingham, UK, 9Derby Hospitals NHS Trust, Royal Derby Hospital,UK

Introduction: Chemo-radiotherapy is the accepted standard of carefor stage III NSCLC worldwide. A phase II study showed inductionchemotherapy followed by CHART to be feasible with outcomesthat were comparable to concurrent chemo-radiotherapy [1]. Wehave conducted a retrospective audit of CHART radiotherapyacross the UK and report on the patients who received sequentialchemotherapy CHART.Methods: We carried out a retrospective analysis of 354 individualsfrom 9 UK centres who underwent CHART between 2003 and2009. A Standard data collection proforma was used to collatedemographic, treatment and outcome data from the centres.Statistical analysis was performed using SPSS, variables governingsurvival were analysed using Log rank test. Toxicity was recordedusing the RTOG common toxicity criteria.Results: 354 patients had stage III NSCLC (AJCC TNM version 62002), 64% were male, median 65 (42 87) and 147 (42%) patientsunderwent induction chemotherapy. Median survival for (stage IIIpatients) was 19.8 months. When variables governing survivalwere analyzed there were no statistically significant prognosticfeatures though there was a trend for improved survival inpatients receiving sequential chemotherapy and CHART (21.0 vs18.2 months p = 0.086). Conversely there was also a trend towardsincreased toxicity for Chemotherapy and CHART patients (78% vs 68%p = 0.053), though no difference in grade 3+ toxicity was reported(4.7% vs 4.1%).

Conclusion: The outcomes for sequential chemotherapy CHARTmirror those reported in the INCH trial [1] and this audit confirms anacceptable toxicity profile. Further studies are required to comparethis strategy to other sequential accelerated chemo-radiotherapyschedules.

Reference(s)[1] Hatton et al. Int J Radiat Oncol Biol Phys 2011; 81: 712 18.

148 Dose escalation in the I-START trial ISoToxic AcceleratedRadioTherapy in locally advanced non-small cell lungcancer

L.S. Nixon1 *, J.F. Lester2, P. Mayles3, H. Mayles3, E. Parsons4,A. Ionescu5, R. Cowles1, A. Nahum3, J. Fenwick6, N. Mohammed7,C. Eswar3, Z. Malik3, G. Griffiths1. 1Wales Cancer Trials Unit,Cardiff University, 2Velindre Cancer Centre, Velindre NHS Trust,3The Clatterbridge Cancer Centre NHS Foundation Trust, 4MountVernon Cancer Centre, East and North Herts NHS Trust, 5RoyalGwent Hospital, Aneurin Bevan Health Board, 6University ofOxford, 7The Beatson West of Scotland Cancer Centre, UK

Introduction: I-START is a phase I/II trial of isotoxic radiotherapywhere patients with stage II IIIb non-small cell lung cancer (NSCLC)suitable for radical RT are eligible. All participants will receive 20fractions of RT over 4 weeks.The Phase I aims to establish the maximum tolerated dose (MTD) ofRT to the oesophagus in patients where the oesophagus lies withinthe Planning Treatment Volume (PTV).Method: Phase I is stratified depending on the length of theoesophagus lying within the PTV (Group 1A, �6.5 cm; Group 1B,>6.5 cm) and cohorts of 6 or 12 patients allocated an increasing doseuntil MTD is reached. Progression to the next dose level dependson toxicity occurring up to 2 months after RT. Patients where nooesophagus lies within the PTV were entered into Phase II andthe dose individualised to a maximum of 65 Gy in 20 fractions.Patients were enrolled after consent but before the planning hadbeen finalised.Results: The current recruitment is 62 patients, two have beenwithdrawn as could not receive the minimum of 55 Gy. The remainingpatients were allocated as shown in the table.

Phase Group Number ofpatientsenrolled

No. of patientswho received theallocated dose

No. where allocated dosecould not be given andmoved to Phase II

I 1A C1 (58 Gy) 6 6 01B C1 (58 Gy) 9 6 31A C2 (61 Gy) 9 6 31B C2 (61 Gy)(open)

6 2 4

1A C3 (63 Gy)(open)

9 3 6

II (65 Gy) (open) 20 12 Not applicable

IMRT was used in two patients and it was possible to reach a higherdose in these cases than with conventional treatment.Low rates of SAEs have been reported to date with only 1 caseof G3 oesophagitis. From the phase 2 patients recruited to date itdoes appear to be possible to escalate the dose above the currentstandard practice (55 Gy) in an individualised way.Conclusion: Dose escalation is limited by dose constraints toknown organs at risk; more advanced planning techniques may beneeded to effectively determine the maximum tolerated dose tothe oesophagus.I-START is funded by Cancer Research UK (C25518/A11535) andsponsored by Velindre NHS Trust. JL is supported by NISCHR AHSC.