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Vienna, Austria

ESTRO 2023

Session Item

Saturday
May 13
10:30 - 11:30
Business Suite 1-2
Lung 1
Jose Belderbos, The Netherlands
Poster Discussion
Clinical
Health-related quality of life in the randomised ARTFORCE PET-Boost trial in locally-advanced NSCLC
Saskia Cooke, The Netherlands
PD-0155

Abstract

Health-related quality of life in the randomised ARTFORCE PET-Boost trial in locally-advanced NSCLC
Authors:

Saskia Cooke1, Jose Belderbos1, Bart Reymen2, Maarten Lambrecht3,4, Gitte Fredberg Persson5,6,7, Corinne Faivre-Finn8, Edith Dieleman9, Judi van Diessen1, Jan-Jakob Sonke1, Dirk De Ruysscher10

1Netherlands Cancer Institute (NKI-AVL), Radiation Oncology, Amsterdam, The Netherlands; 2MAASTRO Clinic, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, Radiation Oncology, Maastricht, The Netherlands; 3KU Leuven – University of Leuven, Department of Oncology, Experimental Radiation Oncology, Leuven, Belgium; 4University Hospitals Leuven, Radiotherapy-Oncology, Gasthuisberg, Belgium; 5Copenhagen University Hospital - Rigshospitalet, Department of Oncology, Copenhagen, Denmark; 6Copenhagen University Hospital – Herlev and Gentofte, Department of Oncology, Copenhagen, Denmark; 7University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark; 8University of Manchester, The Christie NHS Foundation Trust, Clinical Oncology, Manchester, United Kingdom; 9Amsterdam University Medical Centers location AMC, Radiation Oncology, Amsterdam, The Netherlands; 10MAASTRO Clinic, GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, Radiation Oncology , Maastricht, The Netherlands

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Purpose or Objective

In patients with locally advanced non-small cell lung cancer (LA-NSCLC), the ARTFORCE PET-Boost trial (clinicaltrials.gov: NCT01024829) showed that two isotoxic, personalised, dose-escalation strategies resulted in excellent 1-year freedom from local failure rates of >90% at 1-year, as compared to the historic rate of 70%. However, dose-escalation comes at an increased risk of adverse events. In this study we assessed the impact of these two dose-escalation strategies on health-related quality of life (HRQoL).

Material and Methods

Patients with stage II/III NSCLC and ≥4cm diameter primary tumour were randomised in 7 European institutes to receive 24 fractions escalated fraction dose either to the primary tumour as a whole (arm A, n=54), or to an FDG-directed subvolume within the primary tumour (arm B, n=53). Patients completed EORTC QLQ-C30 and LC30 questionnaires at baseline, twice during treatment, and at 1,3,6,12, and 18 months after end of treatment. Scores were linearly transformed to a scale of 0-100. A linear mixed effect (LME) model was used to estimate the effect of treatment group and time on the QLQ-C30 Sum Score. Additionally, in individual patients, a difference of ≥10 was considered a clinically relevant difference in functioning and symptom scores. Changes from baseline at 3- and 12-months in physical functioning, dyspnea and overall health/QoL were endpoints of interest.

Results

In total, 50 and 52 patients were included in the current analysis in arm A and B, respectively. Most patients had stage III disease (88%), and received concurrent chemotherapy (73%). Median gross primary tumour volume was 110cm3 (IQR 65-179). Median mean physical dose to primary tumour was 77.2Gy (IQR 74.2-80.4) and 74.3Gy (IQR 72.4-78.4), in arm A and B respectively. At baseline, 1, 3, 12, and 18-months, respectively, 86%, 62%, 85%, 80% and 72% of alive patients completed the questionnaire.

Baseline C30 and LC13 scores were comparable between the two treatment arms. Fig.1 shows C30 sum score over time. In the LME model, the C30 sum score did not clinically relevant or statistically significantly differ between treatment arms over time.

There were no statistically significant differences between the two arms in the change from baseline scores at 3- and 12-months in PF or overall health/QoL. At 3-months, 50.0% and 39.3% experienced a ≥10 point worsening in dyspnoea, while 20.6% and 39.3% experienced improvement (Mann-Whitney, p=0.20), in arms A and B, respectively. In dysphagia, 8.6% and 31.2% experienced a ≥10 point worsening, while 5.7% and 6.2% experienced improvement, respectively (p=0.05). In fatigue, 54.3% and 38.7% experienced a ≥10 point worsening, while 22.9% and 38.7% experienced improvement (p=0.15).


Conclusion

We observed no statistically significant different impact of dose-escalation strategy on HRQoL through time. On an individual level, 32.8% experienced a clinically relevant deterioration, while 27% experienced improvement in overall health/HRQoL.