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Kevin Rogacki

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    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.16-27 - Using Rates of Clinical Brachial Plexopathy after Lung SBRT to Better Characterize the Tolerance of the Brachial Plexus (ID 12741)

      16:45 - 18:00  |  Author(s): Kevin Rogacki

      • Abstract
      • Slides


      Treatment of apical lung tumors with stereotactic body radiation therapy (SBRT) can be challenging due to proximity to the brachial plexus (BP). We retrospectively investigated outcomes after treatment of apical lung tumors to compare the rate of brachial plexopathy (BPX) with what would be estimated based on published protocol-derived BP constraints.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Apical lung tumors were defined in this analysis as those whose lung SBRT target had a planning-derived PTV edge <1cm from the anatomic BP. We surveyed an IRB-approved prospective registry of 1,462 patients treated with SBRT for the interval 2003-2017 and included all patients who received definitive or salvage SBRT using dose/fractionation schedules of 50 Gy/5 fx, 60 Gy/5 fx, or 48 Gy/4 fx. Salvage SBRT included patients with local recurrence after conventional fractionation radiotherapy. Per RTOG protocols, the subclavian vein (SCV) ipsilateral to target was contoured as the BP surrogate. In this study, the ipsilateral subclavian artery (SCA), and BP were also contoured to characterize dosimetric differences between structures. Statistical analysis involved repeated measures ANOVA.

      4c3880bb027f159e801041b1021e88e8 Result

      Sixty-four patients, which includes six patients (9.4%) receiving salvage SBRT, met inclusion criteria (median follow up of 21 months). No significant differences (p=0.77) were observed between maximum point doses to BP, SCV, and SCA. Within one year post-SBRT, two patients (3%) developed BPX (grade 2); both patients had exceeded 32 Gy to the BP and were treated with salvage SBRT. No patient treated with definitive SBRT (91%) developed BP, despite 17 of these exceeding recommended maximum doses.

      8eea62084ca7e541d918e823422bd82e Conclusion

      No BPX was observed for patients that exceeded a maximum dose of 32 Gy to the BP, unless they were treated as salvage SBRT. This suggests higher doses to the BP may be considered when clinically required for definitive SBRT. However, salvage SBRT may require more conservative BP constraints than used in the definitive setting.


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