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C. García-Sancho
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P2.02 - Poster Session with Presenters Present (ID 462)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-062 - Alterations in Pulmonary Function Tests Predict the Development of Radiation-Induced Pneumonitis in Advanced NSCLC (ID 4948)
14:30 - 14:30 | Author(s): C. García-Sancho
- Abstract
Background:
Chemo and radiation therapy are the standard of treatment in patients with locally advanced NSCLC. Radiation pneumonitis is a frequent complication and its presence is associated with severe symptoms that decrease the quality of life and might result in pulmonary fibrosis or death.
Methods:
Prospective study from June 2013 to July 2015, in patients treated with concurrent chemoradiation for NSCLC at the Instituto Nacional de Cancerología of Mexico. All patients had pulmonary assessment at baseline (prior to chemoradiation) and at 6 weeks, 3, 6 and 12 months (end of chemoradiation). The pulmonary function tests (PFT) included: spirometry, pletismography, oscilometry, diffusing capacity for CO2, molar mass of CO2, arterial gasometry, 6 minutes walk and fraction of exhaled NO (FENO). Radiation pneumonitis was evaluated by RTOG criteria and the CTCAE V.4.0. The study was approved by the ethics committee and was registered in clinicaltrials.gov (NCT01580579).
Results:
Overall 52 patients were included and 37 patients completed one-year follow-up. Severe pneumonitis developed in 11/37 (29%) and 15/37 (40%), according to the RTOG criteria and the CTCAE V.4.0, respectively. Factors associated with pneumonitis development included age and dose per fraction (>250cGy). We observed as well that patients who developed pneumonitis had more often central and lower tumors, and percentage of irradiated lung with 20Gy greater than 35% (PA V20>35%) and 5Gy over 65% (PA V5>65%). PFTs alterations prior to treatment that identified the development of severe pneumonitis included: a lower forced expiratory volume in one second after bronchodilator (FEV1, p= <0.02), ratio for the residual volume between total lung capacity (RV/FTA, p= < 0.02) and FENO (p= <0.04). All PFTs showed changes at the end of chemoradiation, particularly between the third and sixth month of treatment, with a slight recovery at 12 months, without returning to basal values. Although patients who developed pneumonitis had a greater deterioration in the spirometry and plethysmography, changes in PFTs during the first 12 weeks not predicted the development of pneumonitis.
Conclusion:
Alterations in FEV1, RV/TLC and FENO, prior to concomitant chemoradiation predict the development of severe pneumonitis in NSCLC. This study suggests that all patients who receive chemoradiation to the lung must be assessed by PFTs in order to identify patients at high risk for radiation pneumonitis, and have a close follow-up with an early start (beginning of symptoms) of steroids to reduce long-term complications.
