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Robert Milroy

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    P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)

    • 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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      P2.17-02 - Cardiopulmonary Exercise Tests in Lung Cancer Patients Treated Radical Radiotherapy and Chemotherapy – Feasibility Study (ID 14145)

      16:45 - 18:00  |  Author(s): Robert Milroy

      • Abstract
      • Slides


      Cardiopulmonary exercise testing (CPET) is based on the principle that system failure can be detected when the system is under stress. CPET allows measurement of peak oxygen consumption (peak VO2), the gold standard measure of exercise performance, and can identify the causes of exercise limitation. Variables measured at CPET can predict mortality in various disease states and is used to assess fitness for surgery. Lung cancer patients often have pre-existing cardiopulmonary disease, however there is limited data on the role of CPET in patients treated with radical radiotherapy (RRT). Recent RTOG 0617 study reported worse survival with RRT dose escalation, which was attributed to cardiopulmonary toxicity. This study aimed to investigate the feasibility of using CPET to study the effects of RRT on exercise capacity and to assess its cardiac and pulmonary components.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      During the period 2003 – 2009, NSCLC patients undergoing RRT consented to participate in this prospective study. Alongside standard incremental CPETs, patients were assessed with pulmonary function tests and standardized measure of activity of daily living, the London Chest Activity of Daily Living scale (LCADL) at four different time points: pre-RRT and at 6 weeks, 6 months and 12 months post RRT.

      4c3880bb027f159e801041b1021e88e8 Result

      Thirty-eight patients participated. Median age was 66 years, and Karnofsky Performance Status >70. Using TNM 5th Edition, staging was T1-2/T3-4 = 50%/50%, N0-X/N1-2 = 50%/50% and M0/1 = 92%/8%. Planned RRT was completed by 34 pts.

      Over the 12 months the peak VO2 (l/min) decreased (p overall = 0.009) from a median 0.83 by a maximum of 0.12 at 6 m, thus demonstrating a decline in exercise performance.

      The VE/CO2AT increased (p overall = 0.005) post RT from a median 40, most clearly at 3 months (5, p=.028). Furthermore peak alveolar-arterial (A-a) gradient increased (p overall =.001) from a baseline median value of 38.5 at 6w (3.15, p=.046) and 3m (5.75, p=.013) respectively. These results indicate a decline in ventilatory efficiency following RRT.

      No significant changes were seen in oxygen pulse, a surrogate measure of cardiac function.

      LCADL completion reduced after 6w. The median baseline score was 22 and a statistically significant difference could not be detected over time (p overall = 0.502)

      8eea62084ca7e541d918e823422bd82e Conclusion

      The results indicate that CPET is able to detect a decline in exercise performance after RRT and that in this study the decline appears to be driven by a reduction in respiratory function. These results require confirmation in a larger study.


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