Author of

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  P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall

  • 27378

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    P3.01-25 - Feasibility of Moderate Hypofractionated Thoracic Irradiation for Non-Small Cell Lung Cancer Patients with Very Limited Lung Function (ID 13457)

    12:00 - 13:30  |  Author(s): Cherylina Wijaya
    • Abstract
    • Slides

    Background
    

    To determine the feasibility of moderate hypofractionated image-guided thoracic irradiation (modHypo-IGRT) in locally advanced node-positive non-small cell lung cancer patients with very limited pulmonary function.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    Eight selected patients with highly diminished pulmonary function (FEV1 ≤ 1.0L and/or DLCO ≤ 40% and/or long-term oxygen therapy) were treated with modHypo-IGRT. Planning was based on 18F-FDG-PET/CT and 4D-CT. Gross tumor volume (GTV) included primary tumor and involved lymph nodes. Internal target volume (ITV) was defined through the overlap of GTVs on 10 phases of 4D-CT. An isotropic margin of 5 mm was added to ITV to generate the planning target volume (PTV). modHypo-IGRT was delivered to a total dose of 45 Gy (ICRU) in 15 daily fractions under strict image-guidance. Vital capacity (VC), forced expiratory volume in 1s (FEV1), and single-breath diffusing capacity of the lung for CO (DLCO-SB) were analyzed prior to, 3 and 6 months after modHypo-IGRT.

    4c3880bb027f159e801041b1021e88e8 Result
    

    Eight patients completed modHypo-IGRT. The median follow-up was 20 months. The median age was 64 years. Two, 4 and 2 patients presented with stage IIIA, IIIB, and IIIC. Seven patients were with performance status ECOG 2 and 1 with ECOG 3. Five patients (63%) were on long-term oxygen. Three patients received chemotherapy prior to modHypo-IGRT. The median PTV was 226.9 cm³ (range: 100.17 - 379.80). The median overall (OS) and progression-free survival (PFS) for the entire cohort were not reached. The 1- and 2-year OS rates were 100% and 87.5%. The 6- and 12- months PFS rates were 100% and 63%. 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 radiation esophagitis. 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. Median value for VC, FEV1 and DLCO-SB 3 months after modHypo-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). At 6 months post-treatment, the median 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%).

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    modHypo-IGRT can be considered for individual patients with locally advanced node-positive NSCLC patients with very limited pulmonary function hence inadequate for conventional treatment. This protocol is being assessed in an ongoing single-center prospective study.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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