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E. Gore
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P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.01-036 - The Safety and Efficacy of Thoracic Reirradiation (ID 3070)
09:30 - 09:30 | Author(s): E. Gore
- Abstract
Background:
Intrathoracic malignancies including lung, esophageal, and pulmonary metastases frequently recur locally or regionally after initial therapy. The existing literature on the safety and efficacy of multiple courses of thoracic irradiation is limited. The purpose of this study was to evaluate local regional control and toxicity in patients who received up to three courses of thoracic radiation.
Methods:
We conducted a retrospective review of 51 patients who had undergone at least two courses of thoracic radiation. Two patients were found to have only a previous course of whole breast irradiation and were thus excluded for a total of 49 patients. Patient age, diagnosis, courses and doses of radiation therapy, chemotherapy and surgery were extracted from the record. Time to recurrence was determined by time from last radiation treatment to pathological confirmation or radiographic progression. Six potential treatment related grade 4 or 5 toxicities were identified (5 deaths).
Results:
The median age at diagnosis was 64. Median follow up was 3 years (range 0.76-12). 43 of the patients were with primary lung malignancy, 2 with esophageal, 3 with metastases and 1 unknown. 49 patients received at least two courses of intrathoracic radiation, 5 received 3 courses. 38 patients had died at time of last follow up, 10 were alive and one lost to follow up. 46% had local-regional recurrence at time of last follow up while 24% were disease free. The median cumulative dose was 111Gy for all patients, 113 Gy in those with Grade 4 or higher toxicity (NS). Median survival after completion of the first radiation treatment was 3.2 years. Median survival after completion of the last course of radiation was 1.25 years versus 0.58 years for those without and with Grade 4-5 toxicity respectively. The median time between the first and last course of radiation was 1.7 years. Five of the six patients with severe toxicity were disease free at time of death or last follow up. Grade 5 toxicities included massive hemoptysis, tracheal erosion, cardiac arrest, and respiratory failure. Dosimetric evaluation of these patients is underway. 50% of patients with severe toxicity had previous or subsequent thoracic surgery versus 23% in those without. Median time from end of first treatment to end of last treatment was 634 days (range: 0.39 -7.5 years) versus 465 days (range: 0.6-2.3 years) for patients without and with Grade 4-5 toxicity, respectively. None of the 5 patients who received 3 courses of radiation exhibited severe toxicity.
Conclusion:
Repeat courses of thoracic irradiation appear to be generally safe and effective with a median survival of 1.26 years following the last radiation treatment with 10% Gr4-5 toxicity in this population with cancer specific mortality of 78%. Future studies will identify clinical and dosimetric parameters that predict for severe toxicity.
