Author of

• 20193

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  P3.14 - Radiotherapy (ID 730)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Radiotherapy
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 24192

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    P3.14-002 - Multimodality Management of Pancoast Tumors; Does Surgical Resection Need to Be Included? (ID 9654)

    09:30 - 09:30  |  Author(s): C. Carey
    • Abstract

    Background:
    Tri-modality management using chemoradiotherapy followed by surgical resection is the current standard of care for patients with pancoast tumors. Surgical resection is considered the key element to improve patient outcomes, however it involves a lengthy operative procedure with surgical/anesthetics related side effects, long period of rehabilitation, and significant additional cost. In the era of image-guided radiotherapy, we are able to paint the dose around the tumor, targeting it with a high dose of radiotherapy, while avoiding sensitive organs such as spinal cord and brachial plexus. Here we present our institutional experience treating advanced pancoast tumors with chemoradiotherapy.
    
    Method:
    Patients are usually staged with chest-abdomen CT scan, upper chest/brachial plexus MRI (if needed), brain MRI and a PET scan. Patients are treated in a supine position, using head and neck mask as the immobilization device; and cone beam image guidance. The radiation dose is 45-70 Gy in 25-35 fractions concurrent with at least 2 cycles of chemotherapy. Patients with resectable tumors have surgery done within 4-6 weeks upon completion of chemoradiotherapy. Patients are followed every 3-6 months with CT scan and/or upper chest MRI for 3 years, then yearly after.
    
    Result:
    Of 205 consecutive patients with stage 3-4 NSCLC treated with radical dose radiotherapy at Southlake regional cancer center, 9 patients with pancoast tumor were detected. Two patients (2/9) died; one from a heart attack before completion of his treatment, and the other one from tumor progression (6 months after completion of tri-modality management). All the other 7 patients are still alive and free of disease (table 1).

    Patients	Gender	Age (year)	Tumor size (cm)	Tumor pathology	Tumor invasion	Sugery	RT (Dose/fraction)	Date of completion RT (D/M/Y)	Date of last FU
    1	F	61	6.2	Squamous carcinoma	T2, vessels, bone marrow	No	66 Gy/33 fr	06/02/2010	13/10/2016
    2	M	62	11.3	Adenocarcinoma	C6-T3 ribs	No	70 Gy/35 fr	05/10/2010	25/01/2017
    3	M	72	9	Adenocarcinoma	rib, vessels, neck	No	70 Gy/35 fr	25/01/2011	29/06/2016
    4	M	66	9	Squamous carcinoma	C7-T5 vessels	No	66 Gy/33 fr	26/01/2015	11/01/2017
    5	F	58	5.6	Adeno carcinoma	ribs	Yes	45 Gy/25 fr	21/03/2016	25/04/2017
    6	F	55	6.6	Squamous carcinoma	T2-T4 rib chest wall soft tissue	No	66 Gy/33 fr	04/04/2016	08/06/2017
    7	F	74	4.3	Adenocarcinoma	T3-T4 rib	Yes	66 Gy/33 fr	26/05/2016	20/06/2017

    
    
    Conclusion:
    Selected patients with pancoast tumors treated with high dose radiotherapy, using image guidance, concurrent with chemotherapy may have long term disease free survival. A multi-institutional study is warranted to conclude the management recommendation for these rare tumors.