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Miriam Nuñez Fernandez



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    P2.17 - Treatment of Early Stage/Localized Disease (ID 189)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.17-31 - Central Lung Tumors Treated with Stereotactic Radiotherapy. Toxicity and Early Results in a Single Institution (ID 2635)

      10:15 - 18:15  |  Presenting Author(s): Miriam Nuñez Fernandez

      • Abstract
      • Slides

      Background

      Stereotactic ablative radiotherapy (SABR) for stage I-II inoperable non-small-cell lung cancer (NSCLC) peripherally located has become a standard treatment. However the role in central located lung cancer remains controversial because potential severe toxic effects. When adaptive dose regimens to location and appropriated dose-volume constraints for normal tissues are used, the expected toxicity are mild and the local control are comparable to those for peripheral lesions. We report our experience with central SABR.

      Method

      Retrospective analysis of patients diagnosed with inoperable centrally located early lung cancer, defined as a tumor within 2 cm in all directions of any mediastinal critical structure, who were treated in a single institution between May 2017 and January 2019 with VMAT-SABR. All patients underwent 4DCT simulation. Cone beam CT (CBCT) and fluoroscopy prior and CBCT after to each treatment fraction was performed. Dose to the PTV was prescribed to the 95% isodose line. Acute toxicity was assessed by the CTCAE v.4.03 scale and local control was reported using RECIST criteria.

      Result

      40 patients were treated with stereotactic ablative radiotherapy for early inoperable NSCLC and 15 male patients had centrally located lesions. The mean age of included patients were 75 years (65-81) with a median follow-up of 6.6 months (2,2-19,8).

      The main cause of inoperability was pulmonary functionalism and cardiac comorbidities. 2 (13%) were treated previously with lobectomy for another primary lung cancer.

      8 (53%) were adenocarcinoma, 2 (13%) were squamous carcinoma and 5 (33%) with no biopsy-proven malignancy. The most frequent location were inferior lobes (53%).

      10 (66%) were stage cT1b-cN0M0, 4 (27%) cT2a-bN0M0 and 1 (7%) were cT3N0M0 (<5cm) as defined by the 8th edition of TNM. In the majority of patients (53%) the mediastinal staging was performed with PET-CT, however 7 patients underwent pathological mediastinal lymph node evaluation (endobronchial ultrasonography in 4 and mediastinoscopy in 3).

      The prescribed dose ranged from 48 Gy to 70 Gy in 4 to 10 fractions. Most patients were treated using 50 Gy in 5 fractions, BED 100 Gy10 (47%), followed by 48 Gy in 4 fractions, BED 105.6 Gy10 (20%) and 60 Gy in 8 fractions, BED 105 Gy10 (20%).

      There were no G3-5 toxicity. Acute G1 toxicities were fatigue (40%), pneumonitis (27%), dermatitis (13%) and cough (7%). 1 patient presented acute toxicity consistent with cough G2.

      At last follow-up, in terms of disease control, 87% the lesions had partial response or stable disease. 1 patient had local progression. 13 patients (87%) were alive and 2 (13%) died.

      Conclusion

      In our serie, VMAT-SABR for centrally located lung tumors is safe and effective and should be considered for its acceptable acute toxicity profile and good early results.

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