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Steven Feigenberg



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    P2.01 - Advanced NSCLC (ID 159)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.01-65 - Temporal Changes of Radiation-Induced Lung Injury Following Proton Therapy for Non-Small Cell Lung Cancer (NSCLC) (Now Available) (ID 1715)

      10:15 - 18:15  |  Author(s): Steven Feigenberg

      • Abstract
      • Slides

      Background

      Proton therapy (PT) is increasingly being used in locally advanced non-small cell lung cancer (NSCLC), but is there currently a limited understanding of its radiation-induced lung injury pattern that can cofound radiologic interpretation. Here we characterize imaging of radiation-induced lung injury on CT (computed tomography) and FDG-PET (18F-deoxy-glucose-positon emission tomography) following PT.

      Method

      After institutional IRB approval, longitudinal imaging from adult NSCLC patients undergoing PT over a 5-year period at our institution were retrospectively analyzed by two thoracic radiologists. Tumor size and FDG standard uptake value max (SUVmax) were recorded. In addition, early (<12 months after PT) and late (>12 months) radiation-induced lung injuries were quantified (0-3 Likert score), including consolidation, ground glass, interlobular septal thickening, bronchiectasis and pleural effusion, on all serial imaging.

      Result

      iaslcfig_submitted.jpg

      19 consecutive locally advanced NSCLC patients (mean age 69.3 yrs) had PT during the study period and had serial images available for review. The mean imaging follow-up period from PT start was 30 months. Five patients developed local failure. In the remaining 14 patients, tumor size and FDG avidity steadily decreased over time (mean SUVmax = 10.8 at baseline and 2.5 at 12 months). Ground glass and interlobular septal thickening presented as early changes, increasing through months 6-12 and 9-12 respectively but generally resolved by 24 months. 68% of patients developed a pleural effusion (< 2 years), increasing in severity over the 1st 18 months.

      Consolidation consistently increased in severity throughout the observation period (max >48 months) Among 11 tumors, 8 achieved maximum severity in late changes of band-like or mass-like consolidation within 24 months and then typically plateaued. Late development of a pleural effusion, mass-like fibrosis, increased tumor caliber and increased FDG avidity were associated with local tumor recurrence.

      Conclusion

      Radiation-induced lung injury follows a predictable temporal pattern on CT. Knowledge of expected timeline of the imaging findings may prevent unnecessary imaging and/or biopsies. We are currently analyzing a larger cohort of 100 NSCLC patients to compare post radiation changes in local recurrence and local control.

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