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N. Woody
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MA 09 - The Current Status of Radiation Oncology (ID 666)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:Tomoki Kimura, Yong Chan Ahn
- Coordinates: 10/17/2017, 11:00 - 12:30, Room 316
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MA 09.04 - Increasingly Abnormal Pre-Treatment Diffusion Capacity Is Associated with Greater Local Failure After Lung SBRT (ID 7391)
11:25 - 11:30 | Author(s): N. Woody
- Abstract
- Presentation
Background:
We hypothesized that impaired pulmonary functions tests might predict for altered lung density which would interfere with the efficacy of radiotherapy. We therefore sought to determine if there are associations between pre-treatment [preTx] forced expiratory volume in 1 second (FEV1, in L and as % predicted [%p]) and diffusion capacity (DLCO, as %p) with local failure (LF) rates seen with lung stereotactic body radiotherapy (SBRT) for medically inoperable lung cancer.
Method:
From an IRB-approved institutional prospective SBRT registry of 1330 patients, we identified 557 treated definitively for medically inoperable early stage T1-T3N0M0 non-small cell lung cancer (NSCLC) between 2003 and 2016 for whom both preTx FEV1 and DLCO were available. Lung SBRT dose/fractionation for a given pt was at the discretion of the treating physician. LF was defined as progressive and increasing CT scan abnormalities confirmed by progressive and incremental increases in lesion SUVs on serial PET imaging, with or without biopsy. Predictors of LF were determined using competing risks regression and rates of local control were determined from cumulative incidence analysis.
Result:
Pt characteristics included: female gender (52.6%); median age 74 years (range 42-95); median KPS 80 (range 50-100); median preTx FEV1 and DLCO: 1.39L (range 0.26-3.87), 60 %p (range 13-151) and 52 %p (range 10-143), respectively. Tumor characteristics included: median diameter 2.2 cm (range 0.7-7.2); median PET SUVmax 7.7 (range 0.8-56); % as T stage 1a, 1b, 2a, 2b, 3: 40.2; 35.5; 18.9; 4.5; 0.9, respectively; “central” location (per RTOG 0813) 22.6%. Median follow up was 18.3 months. At analysis, 46.9% pts were alive. Treatment characteristics included 50 Gy/5 fractions (fx) for 235 pts (42.2%), 60 Gy/3 fx for 167 pts (30%), and other schedules for 155 pts (27.8%), with the latter excluded from analysis due to variability in schedules, leaving 402 pts (72.2%). Only dose was significantly associated with LF on multivariable analysis [p=0.0057; HR =3.416, 95% CI 1.429-8.166]. Three-year cumulative incidence of LF post-SBRT for 50 Gy/5fx and 60 Gy/3 fx was 15.2% and 2.3% [p=0.024], respectively. In subset analysis of the 50 Gy/5 fx, DLCO was significant for LF both as a continuous variable and as a categorical variable. The significant cut-off for DLCO was 45%p, such that 3-year LF at <45 was 24.7% (95% CI 13.6-35.8) and at > 45 was 10.6% (95% CI 5.3-16.0), [p=0.0234; HR =0.441, %95 CI 0.217-0.895[CR1] ]. There were no significant associations between LF and pulmonary functions tests for 60 Gy/3 fx.
Conclusion:
As preTx DLCO drops below 45 %p, our findings suggest local failure increases when lung SBRT is delivered as 50 Gy/5 fx for early stage NSCLC. This warrants validation in prospective series.
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P1.14 - Radiotherapy (ID 700)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.14-003 - Anesthesia Allows Safe Administration of SBRT for Early Stage Lung Cancer Patients with Advanced Cognitive Impairments (ID 7394)
09:30 - 09:30 | Author(s): N. Woody
- Abstract
Background:
Lung stereotactic body radiotherapy (SBRT) for medically inoperable early stage lung cancer involves extremely precise delivery and requires robust systems for patient (pt) immobilization, breathing control, and daily image guidance. Severe cognitive impairments [CIs] in pts may interfere with their suitability for lung SBRT. Herein, we report on the pt/tumor/treatment characteristics of CI cases for which out-pt anesthesia [OPA] was employed to ensure safe and rigorous SBRT delivery.
Method:
A survey of an IRB-approved institutional prospective SBRT registry of 1330 pts for the interval April 2004 to December 2016 revealed 7 pts with medically inoperable early stage T1-T3N0M0 non-small cell lung cancer (NSCLC) requiring OPA. SBRT was delivered by a stereotactic-specific LINAC platform with vacuum-bag based immobilization, and CBCT +/- infrared-based X-ray positioning system for image-guidance. Tumor motion management involved an abdominal compression device in all cases and SBRT dose/fractionation was selected at the discretion of the treating physician.
Result:
Seven OPA cases were treated between March 2006 and July 2016. Pt characteristics included: female sex (71.4%); median age 66 years (range 44-66); median Karnofsky performance status 70 (range 40-80). Four pts completed spirometry: median FEV1 was 1.005 L and 41 % predicted; only 2 were able to do diffusion capacity testing. CI causes were: Alzheimer’s related dementia (n=3); chronic schizophrenia requiring institutionalization (n=3); severe mental disability from birth with tracheostomy (n=1). Tumor characteristics included: median diameter 3.8 cm (range 1.7-10.5); median PET SUVmax 10.5 (range 6.4-25.5); T stage 1a – 2 pts; 1b – 1 pt; 2a – 2 pts, 2b – 1 pt, 4- 1 pt; “central” location (per RTOG 0813): 6 pts. Treatment doses included 50 Gy/5 fractions (fx) in 3 pts, 60 Gy/3 fx in 1 pt, 60 Gy/8 fx in 2 pts and 50 Gy/10 fx for 1 pt. OPA consisted of a propofol 10mg/ml-including IV sedation regimen in all cases and was done at the time of simulation and daily with treatments. All SBRT was completed as planned. There were no complications attributable to OPA and no post-OPA hospitalizations. Median follow up was 17.7 months (range 6.6-105.5). At analysis, 5 pts (71%) were alive. One pt died of a grade 5 tracheo-esophageal fistula in the absence of cancer at 8.2 months after SBRT, otherwise there were no grade 3 or higher toxicities. One pt died from biopsy-proven loco-regional failure 105.7 months after SBRT. Otherwise, there has been no other local, regional nodal or distant failure at the time of analysis.
Conclusion:
OPA facilitated lung SBRT delivery for pts with CIs. SBRT outcomes were in keeping with expected values. CIs should not be considered contraindications to safe lung SBRT delivery in pts otherwise appropriate for this modality.
