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Federico Maldonado Magos
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P1.01 - Advanced NSCLC (ID 158)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.01-117 - Pulmonary Function Monitoring in Patients with Oligometastatic NSCLC Who Receive Stereotactic Body Radiation Therapy (ID 2044)
09:45 - 18:00 | Author(s): Federico Maldonado Magos
- Abstract
Background
Patients with early and oligometastatic stage Non-small cell lung cancer (NSCLC) who are non-surgical candidates benefit from new radiation treatment modalities, such as stereotactic body radiotherapy (SBRT). Previously we reported the correlation of lung function decline and the presence of lung toxicity related to concomitant chemo-radiotherapy. This work aims to evaluate lung function performance after SBRT in patients with oligometastatic NSCLC.
Method
A one-year prospective multicentric study was conducted at the Instituto Nacional de Cancerología in Mexico. Twenty-six patients with stage IV NSCLC with a single metastasis considered non-operable were treated with SBRT. Lung function was assessed at the baseline and at one, six, twelve, twenty-four and fifty-two weeks after SBRT, using forced spirometry with a bronchodilator, a carbon monoxide diffusing capacity (DLCO) test and oxygen saturation (SpO2) measurement. The study was registered in clinicaltrials.gov (NCT01580579).
Result
Fourteen patients were evaluated with lung function tests, the results were adjusted for the Mexican population. At baseline, the mean for post-bronchodilator (post-BD) FVC (l) was 2.16 (±1.09), for FEV1 2.25 (±1.06), DLCO (ml/min/mmHg) 20.22 (±8.44) and SpO2 of 94% (±2.81). A reduction of <10% of relative change (max. 294 ml) was observed in lung volume in FEV1 and FVC (l) post-BD follow-up with non-significant results. A statistically significant reduction in DLCO 18% (p=0.03) at week 12 was observed, Fig.1. All patients maintained an oxygen saturation level over 90% during the study. Quality of life reduces significantly at week six after SBRT (p=0.03), while respiratory symptoms were non-considerable in the first 12 weeks after receiving SBRT.
Conclusion
Although lung function tests showed a reduction trend, no statistically significant differences were found. The magnitude of lung volume reduction had no significant impact on respiratory symptoms, these findings could suggest that there is less damage in the surrounding tissue after SBRT. This research is an ongoing prospective study of one-year follow-up where several patients continue the be monitored; therefore, we expect to strength our findings by the end of the study.
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P2.08 - Oligometastatic NSCLC (ID 172)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Oligometastatic NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.08-04 - Stereotactic Ablative Radiation Therapy to Lung Metastases Associates with Better Outcomes in Oligometastatic Lung Cancer: Prospective Study (Now Available) (ID 2919)
10:15 - 18:15 | Author(s): Federico Maldonado Magos
- Abstract
Background
Nearly 7% of stage IV Non-Small cell Lung Cancer (NSCLC) patients present oligometastatic disease at diagnosis. These patients can benefit from definitive treatment to primary tumour and loco-ablation of metastases. The use of stereotactic ablative radiotherapy (SABR) has demonstrated high rates of local control and survival improvement in early disease stage. The aim of this study is to evaluate Progression Free Survival (PFS), Overall survival (OS) and toxicity of patients with oligometastatic NSCLC treated with Stereotactic ablative radiotherapy (SABR) to lung metastases.
Method
A prospective study was conducted with oligometastatic NSCLC patients. From August 2014 to April 2019, with a median follow up of 13 months, forty-seven patients were enrolled. All patients received systemic therapy according to international guidelines. Then, patients without progression to systemic treatment, received SABR to lung metastases (30-60 Gy in 2-8 fractions) to the thoracic lesion (primary or metastatic) depending on location, size and number of lesions, always keeping BED (Biologically Effective Dose) >100 Gy at isocenter. This study was approved by Ethic and Research comitees at Instituto Nacional de Cancerología (CEI/799)(013/014/ICI).
Result
Most patients were women (59.6%), with a mean age of 58.9 years. Although two-thirds of patients were ever smokers (66.0%), most of them were light smokers. The most common histology was adenocarcinoma (87.2%). Contralateral lung was the most common metastatic site (40.4%). Half of the patient harbour at least one mutation, EGFR Exon 19 deletion was the most frequent mutation (38.3%). Patients received chemotherapy and EGFR-TKIs as 1st-line treatment in the 61.1% and 38.9%, respectively. All patients received SABR, response to treatment was as follows: disease control rate was 91.5%, partial response 14.9% and complete response 63.8%. Among those with disease progression, median time to systemic progression after SABR treatment was 5.4 months (95% 2.4-8.9 months). PFS since beginning of any treatment was not reached, since only 18 patients (38.3%) had disease progression. Until now only 4 patients (8.5%) had died, thus OS is not reached. Radiographic pneumonitis was observed in 72.2% (13 patients). Grade 1, 2 and 3 pneumonitis were observed in the 69.2% (9/13), 7.7% (1/13) and 23.1 (3/13) of the patients with pneumonitis.
Conclusion
SABR is a suitable and has a moderate toxicity profile. SABR is a therapeutic option for patients with oligometastatic NSCLC. SABR have shown to improve local control and increase progression-free survival. Future clinical trials are required to evaluate SABR against other treatment modalities.
