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R. Malik



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    P2.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 213)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      P2.03-029 - SBRT for Localized Central NSCLC Conventional Radiation Failures; Recurrent Laryngeal Nerve Paralysis Is a Novel Toxicity (ID 1678)

      09:30 - 09:30  |  Author(s): R. Malik

      • Abstract

      Background:
      To report local control, overall survival and toxicity following robotic SBRT for localized central NSCLC conventional radiation failures.

      Methods:
      Patients presenting with localized central recurrent NSCLC within previously treated radical conventional radiation fields (> 60 Gy) salvaged using robotic SBRT in 5 fractions were retrospectively reviewed. Recurrences were considered central if they involved the hilum or mediastinum.

      Results:
      Twenty patients were treated over a 10-year period and followed for a minimum of 2 years or until death. Eight presented with hilar recurrence and twelve recurrences involved the mediastinum. Seventeen patients had gold fiducials placed for tumor tracking via bronchoscopy; three mediastinal tumors were tracked using the spine as a reference structure. A cumulative dose of 25 to 45 Gy (median, 35 Gy) was delivered to the gross tumor volume (GTV) in 5 fractions. The median GTV was 84 cc (range, 6 to 300). At median potential follow-up of 32 months, the 1-year Kaplan-Meier local control and overall survival estimates were poor at 34% and 40%. However, 1-year Kaplan-Meier local control and overall survival were improved at 67% and 67% when doses greater than 35 Gy were delivered. Two patients with hilar tumors developed acute radiation pneumonitis (Grade III) following 35 Gy and 40 Gy. Two patients with recurrent superior mediastinal tumors unexpectedly developed permanent recurrent laryngeal nerve paralysis (Grade II) 12 months following 40 Gy. One patient with recurrent hilar tumor experienced transient hemoptysis (Grade III) and benign pleural effusion (Grade II) 32 months following 45 Gy.

      Conclusion:
      Robotic SBRT is a novel salvage treatment option for localized NSCLC central recurrence following radical conventional irradiation. Dose escalation beyond 35 Gy resulted in improved local control and survival. However, doses > 35 Gy also resulted in significant toxicity including acute radiation pneumonitis, pleural effusion, hemoptysis and newly described permanent recurrent laryngeal nerve paralysis.

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    P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      P3.02-037 - Robotic SBRT with Fiducial Tracking for Inoperable Peripheral Stage I NSCLC: Mature Survival and Toxicity Outcomes (ID 2960)

      09:30 - 09:30  |  Author(s): R. Malik

      • Abstract

      Background:
      Surgery is not an option for many patients with stage I non-small-cell lung cancer (NSCLC). Here we report mature robotic stereotactic body radiation therapy (SBRT) with fiducial tracking outcomes for inoperable patients with peripheral clinical stage I NSCLC.

      Methods:
      Inoperable patients with biopsy-proven peripheral clinical stage I NSCLC were treated. PET/CT imaging was completed for staging. Three-to-five gold fiducial markers were implanted in or near tumors to serve as targeting references. Gross tumor volumes (GTVs) were contoured using lung windows. The margins were expanded by 5 mm circumferentially to establish the planning treatment volume (PTV). Doses delivered to the PTV ranged from 45 to 60 Gy in 3 or 5 fractions (BED Gy~10 ~>100 Gy).

      Results:
      Forty patients ranging in age from 62-94 years (median age 76 years) with a median percent predicted FEV1 of 61% (range, 21-107%) were treated over a 6-year period extending from August 2005 to August 2011 and followed for a minimum of 40 months or until death. The median maximum tumor diameter was 2.6 cm (range, 1.4-5.0 cm). A median dose of 50 Gy was delivered over a 3 to 13 day period (median, 7 days). At a median potential follow-up of 56 months, the 5-year Kaplan-Meier locoregional and distant control estimates were 95% and 82%. The 5-year cancer-specific and overall survival estimates were 75% and 40%. There was no change in percent predicted FEV1 one year following robotic SBRT; there was a small but statistically significant 8% decline in percent predicted DLCO at one year. Radiation induced rib fracture (RIRF) was identified on surveillance CT imaging in 17 patients. The estimated cumulative incidence of RIRF at 3 years was 40%. The median time to rib fracture was 24 months (range, 7-38 months).

      Conclusion:
      Robotic SBRT with fiducial tracking outcomes for inoperable peripheral stage I NSCLC are comparable to conventional SBRT outcomes. Additional research will be required to determine the optimal SBRT technique.