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H. Williams
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P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.02-037 - Thoracic Radiation-Induced Pleural Effusion and Risk Factors in Patients with Lung Cancer (ID 1397)
09:30 - 09:30 | Author(s): H. Williams
- Abstract
Background:
Pleural effusion is regarded as a frequent late toxicity after thoracic radiotherapy (TRT). However, recent literature is lacking on this toxicity. This study aimed to examine the patient and dosimetric risk factors associated with radiation induced pleural effusion (RIPE) in lung cancer patients treated with TRT.
Methods:
Lung cancer patients treated with TRT having follow-up imaging, CT or PET/CT, were eligible. Pleural effusion of increased volume after TRT without evidence of tumor progression was considered to be RIPE. Parameters of lung dose-volume histogram including percent volumes irradiated with 5 to 55 Gy (V5-V55) and mean lung dose (MLD) were analyzed. Optimal dosimetric thresholds for RIPE were calculated by receiver operating characteristic (ROC) analysis. Associating clinical and treatment-related risk factors for RIPE were detected by univariate and multivariate analyses with SPSS 18.0. Data were considered statistically significant at value of p < 0.05.
Results:
Of 806 consecutive patients who received TRT at two institutions, 205 had post-treatment imaging available and were included in this study. The median (range) age was 63 (34-85) years; Male, Caucasian race, current smokers, stage III and squamous cell cancer accounted for 73.2%, 81.0%, 50.7%, 66.8% and 27.8%, respectively. The median follow-up duration was 14.6 (range, 0.7-80.8) months. Of 51 patients (24.9%) who developed RIPE, 40 had symptomatic RIPE including chest pain (47.1%), cough (23.5%) and short of breath or dyspnea (35.3%). The median (range) RIPE interval from end of TRT was 3.7 (0.6-18.0) months. The RIPE rates of the two institutions were 20.2% and 32.1% with a borderline significance (p = 0.053). Caucasian race (HR = 2.930, 95% CI: 1.197-7.172, p = 0.019) and histology of squamous cell lung cancer (HR = 0.645, 95% CI: 0.425-0.980, p = 0.04) were significantly associated with the low risk of RIPE, while age (p = 0.378), gender (p = 0.071), stage (p = 0.148), radiation dose (p = 0.782) and concurrent chemotherapy (p = 0.173) were not. The whole lung V5, V10, V15, V20, V25, V30, V35, V40, V45, V50 and MLD were significantly higher in patients with RIPE than in those without RIPE (p = 0.007, 0.022, 0.044, 0.048, 0.034, 0.016, 0.010, 0.026, 0.040 and 0.014), and only V5 was the significant predictive factor for both RIPE and symptomatic RIPE (p = 0.007 and 0.021) with the largest areas under ROC curve (AUC = 0.779). Using a cutpoint of 41.5% for V5, the sensitivity and specificity were 100% and 61.5%, respectively.
Conclusion:
Radiation induced pleural effusion is notable. Caucasian race and squamous cell tumor histology may be associated with lower risk of RIPE. The whole lung V5 seems to be a significant risk factor for symptomatic RIPE.
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P3.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 235)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.04-104 - Radiation Pneumonitis: Assessment by Inflammation Imaging with Tc-99m HMPAO - Clinical Trial in Progress (ID 2790)
09:30 - 09:30 | Author(s): H. Williams
- Abstract
Background:
Background: Over 60% of patients with non-small-cell lung carcinoma (NSCLC) require radiation treatment, with an overall cure rate < 10-15% and moderate toxicity in 10-30% of treated patients. While high-dose radiation improves survival, concern over radiation-induced toxicities including radiation pneumonitis (RP) have limited its use. Predicting probability of tumor control and lung toxicity offers a promising strategy for individualized radiation therapy (RT), such as giving higher dose radiation to resistant tumors when probability of toxicity is low, improving the therapeutic ratio. Technetium-99m (Tc-99m) hexamethylpropylene amine oxime (HMPAO) imaging is an established method for evaluation of brain perfusion, tissue inflammation, infection, and abscess localization. Tc-99m HMPAO, a lipophilic biogenic amine that easily crosses the cell membrane into the endothelial cytoplasm, is a sensitive indicator of endothelial cell damage and microvascular injury, penetrating into the alveolar macrophage reflecting impaired alveolar integrity proportional to inflammation and lung toxicity. Once intracellular, it is retained by conversion to hydrophilic nondiffusable form mediated by glutathione oxidation/reduction within the epithelial lining and bronchoalveolar cell, and has been used for non-invasive detection of lung injury proportional to severity. We used Tc-99m HMPAO scintigraphy to semiquantitatively document the presence and severity of lung toxicity in 4 patients undergoing RT for NSCLC.
Methods:
Methods: Four patients with NSCLC (3 Stage IIIB receiving concurrent RT and carboplatin/paclitaxel chemotherapy, 1 Stage IB RT alone) underwent lung computed tomography (CT), positron emission tomography (PET)/CT with 2-deoxy-2-[fluorine-18]fluoro-D-glucose (FDG), ventilation (V)/perfusion (Q) lung imaging with Tc-99m diethylene triamine pentaacetic acid/Tc-99m macroaggregated albumin, and inflammation imaging with Tc-99m HMPAO; at baseline prior to treatment, during RT after 36-50 Gray, and at 3 months following radiation completion.
Results:
Results: All patients had matching V/Q lung abnormalities in the areas of tumor and RT, and tumor-positive baseline FDG PET/CT imaging that showed response to therapy. Three patients without RP had HMPAO imaging that mimicked Q lung imaging on all 3 sequential imaging studies. No patient experienced RP during RT, while one patient experienced grade 1 RP at 3 months, showing progressive increase in HMPAO inflammatory uptake in adjacent lung from baseline to during-RT to 3 months post-RT imaging, not appreciated on FDG PET/CT imaging (Figure 1).
Conclusion:
Conclusion: Tc-99m HMPAO nuclear imaging may provide more sensitive evaluation of the presence and severity of RP. In this case, uptake on during-RT imaging predated, predicted, and confirmed development of grade 1 RP at 3 months. Figure 1
