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Gitte Fredberg Persson
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MA05 - Improving Outcomes in Locoregional NSCLC II (ID 901)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 13:30 - 15:00, Room 105
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MA05.06 - Locally Advanced Lung Cancer Radiotherapy in Deep Inspiration Breath Hold: Dosimetric Benefits from a Prospective Trial (ID 12465)
14:05 - 14:10 | Author(s): Gitte Fredberg Persson
- Abstract
- Presentation
Background
Radiotherapy for locally advanced non-small cell lung (NSCLC) cancer is often complicated by treatment-related toxicity. A toxicity-reducing technique is deep inspiration breath hold (DIBH), where the lungs inflate and the heart is pushed downwards. DIBH is widely applied in breast radiotherapy, but only sporadically in NSCLC. We initiated the INHALE trial, investigating compliance and benefits of DIBH for NSCLC at a single academic institution.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients referred for definitive radiotherapy of locally advanced NSCLC (66Gy/33 fractions) were included from May 2015-Dec 2017. All patients underwent respiratory coaching for voluntary visually guided DIBH and were imaged with PET/CT, 4D-CT and DIBH-CT. Target volumes were defined according to national guidelines. PTV margins were patient- and modality-specific. For all patients, FB and DIBH plans were made with volumetric modulated arc therapy, with equal PTV coverage. The plan with the lowest lung and/or heart dose was chosen for treatment. Normal tissue complication probability for pneumonitis was calculated retrospectively based on a logistic dose response model.
4c3880bb027f159e801041b1021e88e8 Result
The treatment intent was maintained in 69 of included 88 patients (2 were downstaged, 12 upstaged, 2 withdrew consent, other causes in 3). 62/69 were DIBH compliant and in 61 patients a FB and a DIBH plan were made (in one patient, 4DCT image quality was not sufficient). In 54/61 patients, the DIBH plan was chosen for treatment. 3/54 patients lost DIBH compliance within the first few fractions.
All data is presented as median (range), with p<0.001 (Wilcoxon signed rank). Lung volume increased in DIBH by 55% (20-168%). Compared to FB, DIBH reduced mean lung dose from 14.4Gy (1.2-25.3Gy) to 11.8Gy (1.0-20.4Gy), and lung V20 from 23.7% (1.5-47.8%) to 20.8% (1.2-39.7%). Reduced lung dose translated to reduced pneumonitis risk: from 8.6% (2.3-23.3%) to 6.5% (2.2-14.4%). Lung dose constraints were violated in 5/62 patients in FB and 1/62 patients in DIBH.
Mean heart dose was reduced from 3.6Gy (0.1-25.8Gy) in FB to 2.4Gy (0.1-25.3Gy) in DIBH. DIBH reduced mean heart dose in 44/61 patients. The differences between FB and DIBH varied between – 6.6Gy and 8.9Gy, stressing the influence of tumour location on the potential of reducing heart dose with DIBH.
8eea62084ca7e541d918e823422bd82e Conclusion
Benefits of changed anatomy with DIBH were reduced dose to lungs and, for most patients, to the heart. Curative treatment intent could be maintained in more patients. Risk of developing radiation pneumonitis was reduced. Continuous follow up of INHALE patients will reveal how the reduced risk is manifested clinically.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MA17 - New Methods to Improve Lung Cancer Patients Outcomes (ID 918)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Nursing and Allied Professionals
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 13:30 - 15:00, Room 205 AC
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MA17.03 - Shared Decision-Making for Patients with Advanced Non-Small Cell Lung Cancer (ID 12426)
13:40 - 13:45 | Author(s): Gitte Fredberg Persson
- Abstract
- Presentation
Background
Lung cancer is the leading cause of cancer-related death in the world and more than half of the patients have metastatic disease at the time of diagnosis. Although, treatment options are developing rapidly, most patients are facing a poor prognosis. The role of 3rd or 4th line treatment with chemotherapy remains controversial with sparse evidence of efficacy. Therefore, the patient’s preferences become central. Shared decision-making enables the patients to be actively involved in choosing the treatment option that best reflects both medical evidence and individual preferences.
This study examines how patients with lung cancer and their relatives are empowered and supported when they have to make informed choices regarding 3rd or 4th line of treatment. The aim was to develop a model for shared decision-making and to test decision aid tools that enable a collaborative process that takes into account the best available scientific evidence, as well as the patient's values and preferences.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients diagnosed with advanced non-small cell lung cancer, their relatives and the health care professionals were involved in the process that included: 1) Multidisciplinary workshops and workshops with patients and relatives, 2) Training course in communication on existential issues and shared decision-making for health care professionals, 3) Designing and testing five decision aid tools, 4) Creating a Podcast and 5) Evaluation by patient satisfaction surveys.
4c3880bb027f159e801041b1021e88e8 Result
Three strategic focus areas were identified: 1) The meaningful service, 2) considerations in end-of-life care and 3) patient involvement in decision making. The patient reported quality of communication was increased during the study period. The patient satisfaction surveys (n=77 baseline) and (n=60 final evaluation) demonstrated statistical significant improvements from baseline to final evaluation in regard to:1) involving patients in the treatment decisions to the extent they prefer (Pearson Chi-Square, P=0.048) and 2) encouraging patients to ask questions (Pearson Chi-Square, P=0.008). The study improved the health care professionals understanding of the importance of incorporating patients in shared decision-making processes in clinical practice. However, some barriers for implementation were identified, such as changing established behaviour among health care professionals.
8eea62084ca7e541d918e823422bd82e Conclusion
The findings indicate that decision aid tools are useful and related to significant changes in patient experience of the quality of communication. We suggest investigating the feasibility and potential concerns of integrating these tools to a larger extend in clinical practice.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.01-20 - FLT-PET for Detection of Relapse Following Radiotherapy for Lung Cancer. Preliminary Results (ID 12585)
16:45 - 18:00 | Author(s): Gitte Fredberg Persson
- Abstract
Background
Differentiation of relapse from radiation induced changes of the normal lung tissue following radiotherapy for lung cancer is challenging. CT and 18F-fluorodeoxyglucose (FDG) PET/CT has low specificity due to radiation induced changes; and invasive procedures might be unfeasible due to small size, difficult location, or poor lung function. 18F-fluorothymidine (FLT) is a PET tracer that correlates with proliferation. FLT-PET is more specific than FDG-PET and does not accumulate in inflammatory tissue. The aim of this study is to investigate if FLT-PET is a key to better diagnosis of relapse in this difficult situation.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients who had received definitive radiotherapy for lung cancer and who were suspected for having a relapse were included in this prospective clinical study. Patients underwent FDG-PET/CT and FLT-PET/low dose CT within 3 weeks.
PET scans were evaluated visually on a 5-level scale, and the worst graded lung lesion in each patient was selected for semi-quantitative measurements. Reference standard was a retrospective expert analysis based on histology, subsequent imaging, conference decisions, and treatment within 6 months after inclusion. Descriptive statistics and diagnostic accuracy tests were conducted.
4c3880bb027f159e801041b1021e88e8 Result
We present the results from the first 18 patients. All patients had been treated with definitive radiotherapy (66 Gy in 24 or 33 fractions), and 17 patients had concomitant or sequential chemotherapy. FLT-PET was performed 34-541 days after radiotherapy.
7 patients had no evidence of relapse during the follow up period. 11 patients were diagnosed with relapse based on positive biopsy (3), further progression on CT within 6 months (4), further metabolic progression on FDG-PET/CT and cytology suspicious for malignancy (1), progression on the initial FDG-PET/CT and treatment with response (1), or disseminated disease/bone metastases (2).
Maximum standardized uptake value (SUVmax) of FDG and FLT were higher in the lesions with relapse. Mean FDG SUVmax in lesions with relapse vs benign lesions was 13.7 vs 4.9 (range: 4.0-18.0 vs 3.3-6.7). Mean FLT SUVmax in lesions with relapse vs benign lesions was 4.1 vs 2.7 (range: 1.8-6.3 vs 1.7-3.3).
Sensitivity; specificity; positive predictive value (PPV); and negative predictive value of FDG-PET/CT vs FLT-PET were100%;57%;85%;100% vs 73%;100%;100%;78%.
8eea62084ca7e541d918e823422bd82e Conclusion
With a PPV of 100% FLT-PET is a promising non-invasive tool for diagnosing relapse after radiotherapy with the potential to obviate invasive procedures in some patients. Further validation is needed.
6f8b794f3246b0c1e1780bb4d4d5dc53
