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C. Wijaya
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Poster Display session (Friday) (ID 65)
- Event: ELCC 2018
- Type: Poster Display session
- Track:
- Presentations: 2
- Moderators:
- Coordinates: 4/13/2018, 12:30 - 13:00, Hall 1
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114P - Evaluation of pulmonary function parameters after moderate hypofractionated image-guided thoracic irradiation in locally advanced node-positive non-small cell lung cancer patients with very limited lung function (ID 633)
12:30 - 13:00 | Author(s): C. Wijaya
- Abstract
Background:
To evaluate the changes in pulmonary function parameters (PFT) after moderate hypofractionated image-guided thoracic irradiation (Hypo-IGRT) in locally advanced node-positive non-small cell lung cancer patients with very limited lung function.
Methods:
PFT was measured in 8 patients with NSCLC UICC stage IIIA, IIIB and IIIC (UICC 8[th] Edition) and very limited PFT (FEV1 ≤ 1 L and/or DLCO ≤ 40% and/or long-term oxygen therapy) prior to as well as 3 and 6 months after Hypo-IGRT. Vital capacity (VC), forced expiratory volume in 1s (FEV1), and single-breath diffusing capacity of the lung for CO (DLCO-SB) as PFT parameters were analyzed. Hypo-IGRT was delivered to a total dose of 45 Gy (ICRU) in 15 fractions under daily image-guidance.
Results:
Eight patients (5 men/3 women) were treated with Hypo-IGRT. The median follow-up was 20 months. COPD GOLD III and IV was diagnosed in 2 (25%) and 4(50%) patients, respectively. Five (63%) patients were on long-term oxygen treatment. The median initial VC, FEV1 and DLCO-SB was 1.69L/64.8% predicted (range: 1.36–2.66/33–80%), 1L/39.4% predicted (range: 0.78–1.26/28–60%) and 33.3% (range: 13.3–54), respectively. The median value for VC, FEV1 and DLCO-SB 3 months after Hypo-IGRT was 2.05L/56.35% predicted (range: 1.34–2.33/47–81.5%), 1.08L/47.5% predicted (range: 0.74–1.60/30.8–59.59%) and 38.55% (range: 24–68), respectively. At 6 months post-treatment, the mean value for VC, FEV1 and DLCO-SB was 1.64L/66% predicted (range: 1.41–2.79/35.5–75.5%), 1.0L/47% predicted (range: 0.65–1.28/24.5–54.10%) and 31% (range: 27–43%), respectively. The estimated median overall survival (OS) was not reached for the entire cohort.
Conclusions:
No significant decrease in all tested parameters was found until 6 months after Hypo-IGRT. In this small study, Hypo-IGRT was safely delivered in locally advanced node-positive NSCLC patients with very limited lung function who were not suitable candidates for conventional treatment.
Clinical trial identification:
Legal entity responsible for the study:
University Hospital, LMU Munich
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
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117P - Feasibility of moderate hypofractionated image-guided thoracic irradiation for locally advanced node-positive non-small cell lung cancer patients with very limited lung function (ID 626)
12:30 - 13:00 | Author(s): C. Wijaya
- Abstract
Background:
To determine the feasibility of moderate hypofractionated image-guided thoracic irradiation (Hypo-IGRT) in locally advanced node-positive non-small cell lung cancer patients with very limited pulmonary function.
Methods:
Eight patients with NSCLC stage IIIA-C and highly diminished pulmonary function (FEV1 ≤ 1.0 L and/or DLCO-SB ≤ 40% and/or long-term oxygen therapy) were treated with Hypo-IGRT. Planning was based on 18F-FDG-PET/CT and 4-D computed tomography (4D-CT). GTV included primary tumor and involved lymph nodes (short-axis ≥1 cm and/or PET-positive). CTV was not generated. ITV was defined through the overlap of GTVs on 10 phases of 4D-CT. Isotropic margin of 5 mm was added to ITV to generate the PTV. Hypo-IGRT was delivered to a total dose of 45 Gy (ICRU) in 15 fractions under daily image-guidance.
Results:
Eight patients completed Hypo-IGRT. The median follow-up was 20 months. The median age was 64 years. Two (25%), 4 (50%) and 2 (25%) patients presented with NSCLC stage IIIA, IIIB and IIIC, respectively. There were 7 (88%) patients with ECOG 2 and 1 (12%) patient with ECOG 3. Three patients received chemotherapy prior to Hypo-IGRT. Median initial DLCO-SB was 33.3% (range: 13.3–54) and the median initial FEV1 was 1L/39% predicted (range: 0.78–1.26L/28–60%). The median PTV was 226.9 cm³ (range: 100.17–379.80). The median overall survival (OS), progression-free survival (PFS) and distant metastasis-free survival (DMFS) for the entire cohort were not reached. Mean OS was 42 months (95% CI: 31.7–52.6). Mean PFS was 38 months (95% CI: 17.8–45.7). The 1- and 2-year OS rates were 100% and 87.5%. The 6- and 12- months PFS rates were 100% and 62.5%. Three patients developed local failure. Median mean lung dose was 9.4 Gy (range: 5.3–11.6). V15 and V20 for both lungs were 22% (range: 10–25) and 15% (range: 6–19). Median mean esophageal dose was 12.76 Gy (range: 2.1–26.7). There was no case of radiation pneumonitis. Four patients developed grade 2 acute radiation esophagitis.
Conclusions:
This analysis shows that Hypo-IGRT can be considered in locally advanced node-positive NSCLC patients with very limited pulmonary function who are inadequate for conventional therapy.
Clinical trial identification:
Legal entity responsible for the study:
University Hospital, LMU Munich
Funding:
Has not received any funding
Disclosure:
All authors have declared no conflicts of interest.
