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J.Y. Chang
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P1.03 - Poster Session with Presenters Present (ID 455)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.03-012 - Experience with BioSentryTM Tract Sealant System for Percutaneous CT-Guided Lung Nodule Biopsies in an Oncology Population (ID 5727)
14:30 - 14:30 | Author(s): J.Y. Chang
- Abstract
Background:
Tract sealants are being used more frequently to reduce pneumothoraces and chest tube placement in patients undergoing lung biopsy. Use of a sealant plug can produce visible biopsy tracts on follow-up imaging and can mimic the appearance of malignant tract seeding. The purpose of our study was to characterize these tracts and determine the likelihood of malignant seeding to inform further management including localized radiation therapy and/or surgical planning.
Methods:
Over a 15 month period 407 lung biopsies were performed in patients with known or suspected thoracic and extrathoracic malignancies using a BioSentry Tract Sealant System; 321 cases had follow up CT studies. 4 chest radiologists retrospectively analyzed subsequent imaging to determine the incidence, appearance, temporal relationship and evolution of biopsy tracts. Tracts that decreased or did not change on follow-up were considered benign. 10 surgically resected cases were retrospectively examined by a pathologist for malignant tract seeding.
Results:
321 cases were analyzed. 237 (74%) had a visible biopsy tract on CT (95%CI 0.69, 0.78) (primary lung cancer n=90, metastases n=81, benign nodule n=66). All tracts were identified on 1st follow-up imaging at 1-3 months post-biopsy. Tracts were typically serpiginous and smooth or lobulated with a thickness of 2-5 mm. 218/237 (92%) tracts were unchanged over time (mean follow up, 12 months). 15/237 (6.3%) decreased in thickness. Unchanged or decreasing tracts were considered negative for malignant seeding. Increase in tract thickness or nodularity occurred in 4/237 (1.8%), suspicious for malignant tract seeding. 0/90 (0%) biopsy tracts in primary lung cancer showed progressive increase. 4/81 (4.9%) tracts in patients with metastases showed increase (mean, 99 days post-biopsy). 10 resected nodules (5 primary NSCLCs, 5 metastases) had no malignant tract seeding at histology.
Conclusion:
An observable biopsy tract on CT is common after lung biopsy using the BioSentry[TM] device. Tracts from biopsy of primary lung cancers using the BioSentry device had no malignant seeding and they should have no impact on surgical resection or localized radiation therapy. In the study population, patients who underwent lung biopsy for metastasis had a higher than expected rate of malignant seeding manifested by increased track thickness over time, requiring further investigation.
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P2.05 - Poster Session with Presenters Present (ID 463)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.05-015 - Long-Term Outcomes of Prospective Phase П Clinical Trial for Stereotactic Ablation Radiotherapy in Recurrent NSCLC (ID 5386)
14:30 - 14:30 | Author(s): J.Y. Chang
- Abstract
Background:
To evaluate the long-term efficacy, pattern of failure, and toxicity of stereotactic ablative radiotherapy (SABR) for recurrent or multiple primary non-small-cell lung cancer (NSCLC).
Methods:
Patients with histologically confirmed, [18]F-fluorodeoxyglucose ([18]F-FDG)-PET staged, recurrent or multiple primary NSCLC, suitable for SABR (<5 cm, not abutting critical structures, met with SABR dose volume constraints),were prospectively enrolled and treated with volumetric image-guided SABR to 50 Gy in 4 fractions (prescribed to planning target volume). Lobar recurrent disease was defined as recurrence in the same lobe with the same histology after definitive therapy from prior NSCLC (n=9); recurrent or oligo-metastatic disease (<3 lesions) was defined as recurrence with same histology within four years in different lobe (n=35). Multiple primary NSCLC was defined as secondary NSCLC with either different histology, or same histology but located in the different lobe with more than 4 years after initial definitive treatment of prior NSCLC (n=16); synchronous tumors was defined as with two early stage NSCLC in the different side (n=3). Four-dimensional computed tomography (4DCT) was used for simulation and planning. Patients were followed with CT or PET/CT every three months for two years, then every 6 months for three years and then annually.
Results:
From February 2006 to April 2013, 63 patients were enrolled and eligible for evaluation. The median age was 70 years (range 45-86) and median follow-up was 4.2 years (the interquartile range 3.0-7.3 years). A total of 5 (7.9%) patients developed cumulative actual local recurrence within PTV and 18 patients (28.6%) developed any cumulative actual recurrence (local, regional and distant) after SABR. Estimated total local failure rates in the same lobe at 3-, 5-year were both 11.2% (95% CI 6.8-15.6). Estimated 3-, 5-year PFS rates were 60.2% (95% CI 53.7-66.7) and 52.6% (95% CI 43.5-61.7), respectively; corresponding overall survival rates were 64.1% (95% CI 58.0-70.2) and 52.9% (95% CI 45.5-60.3). Three (4.8%) patients developed grade 3 treatment-related adverse events (one [1.6%] dermatitis, one [1.6%] chest wall pain, and one [1.6%] radiation pneumonitis). No patient had grade 4 or 5 event.
Conclusion:
This exploratory prospective study showed excellent 5 years local control, minimal toxicity and outstanding 5 years OS and PFS for recurrent or multiple primary NSCLC treated with SABR, indicating a potential cure for some patients. Close follow up and surveillance after initial definitive treatment should be considered to detect early recurrence in NSCLC.
