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C. Baldotto
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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
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.02-041 - Stereotactic Body Radiation Therapy Associated with Erlotinib for Localized Clonal Progression of Metastatic Non Small Cell Lung Cancer (ID 2454)
09:30 - 09:30 | Author(s): C. Baldotto
- Abstract
Background:
Stereotactic Body Radiation Therapy (SBRT) has been widely used in early stage Non-Small-Cell Lung Cancer (NSCLC) with low toxicity and local control rates above 90%. Experience with this technique in the treatment of metastatic tumors is limited. EGFR receptor antagonist Erlotinib acts as a radiosensitizer and increases the overall survival of patients with metastatic NSCLC harboring mutations of this receptor. Temporary suspension of this drug may cause a quick progression of the disease known as “disease flare.” Reports about the combination of this drug with SBRT are rare and the toxicity of this treatment is practically unknown.
Methods:
We present an 80 years-old, female patient with metastatic NSCLC who was treated with Erlotinib and had her disease controlled for 3 years. The patient underwent SBRT in a small lung lesion of 22mm representing the isolated progression of the disease. Treatment with Erlotinib was briefly suspended for the SBRT to avoid “disease flare.” The patient was treated with a dose of 5000 cGy in 5 fractions delivered by Volumetric Modulated Arc Therapy (VMAT) without using an accessory for rigid immobilization. Treatment was performed by a linear accelerator with 6 MV photon beam and a 2.5mm micro-multileaf collimator. Margins of 5mm from Internal Target Volume (ITV) were applied, which included the tumor and its movements during the breathing cycle, without safety margin for microscopic disease. IGRT was performed daily with Cone Beam kV computed tomography.
Results:
Before undergoing SBRT, the patient had a Carcinoembryonic Antigen (CEA) level of 8 ng/mL. This tumor marker dropped to 3.5 ng/mL immediately and 1.7 ng/mL three months after the procedure. PET-CT 6 months after SBRT showed a reduction from 9.0 to 3.6 in the SUVmax of the lung lesion. Approximately 60 days after SBRT, the patient developed cough and was diagnosed with actinic pneumonitis. Prednisone was started and kept for about a month with complete resolution of the condition. It has been more than 1 year after she underwent SBRT and more than 3 years since she started chemotherapy with Erlotinib. The patient still shows no evidence of new metastatic lesions and remains with good tolerance to chemotherapy.
Conclusion:
Actinic pneumonitis is uncommon after SBRT of lesions with these small dimensions. A dose of 5000 cGy in 5 fractions is considered a conservative approach and all normal tissue constraints were respected in the present case. We believe this side effect to be a result of the radiosensitizer action of Erlotinib when associated with SBRT. We recommend caution when applying SBRT after a recent suspension of chemotherapy with this drug.
