116PD - Short-course, high-dose image-guided radiotherapy in poor risk patients with very central non-small cell lung cancer

Date 14 April 2016
Event European Lung Cancer Conference 2016 (ELCC) 2016
Session Predictive models for chemo- and radiotherapy
Topics Surgical oncology
Non-small-cell lung cancer
Therapy
Radiation oncology
Presenter Hilâl Tekatli
Citation Journal of Thoracic Oncology (2016) 11 (supplement 4): S57-S166. S1556-0864(16)X0004-4
Authors H. Tekatli1, N. Haasbeek1, M. Dahele1, P. de Haan1, W. Verbakel1, E. Bongers1, S. Hashemi2, E. Nossent2, B. Slotman1, S. Senan1
  • 1Radiation Oncology, Vrije University Medical Centre (VUMC), 1081 HZ - Amsterdam/NL
  • 2Pulmonology, Vrije University Medical Centre (VUMC), 1081 HZ - Amsterdam/NL

Abstract

Background

Stereotactic radiotherapy (SABR) is not recommended for very central (or ‘ultra-central’, UC) lung tumors, which are defined as tumors where the planning target volume overlaps the main bronchi or trachea. Elderly and frail patients with UC tumors may be unfit for conventional radiotherapy, or may decline this option. We report on outcomes of hypo-fractionated radiotherapy in 12 fractions of 5 Gy (BED10 = 90 Gy, heterogeneous dose) in patients with UC tumors.

Methods

Patients were evaluated by a thoracic multidisciplinary team and found to be ineligible for conventional radiotherapy, chemo-radiotherapy, or had a localized UC tumor for which SABR was contraindicated. 47 consecutive patients with UC NSCLC treated between 2010–2015 using Volumetric Modulated Arc Therapy were identified in a single institution. Patients with prior thoracic radiotherapy, or with metastasis to sites other than brain or adrenal glands, were excluded. Clinical outcomes and dosimetry were analyzed.

Results

Median age was 78 years, 49% had a WHO performance score ≥2, median PTV was 104.5 cm3 (range 17.7–508.5), and 60% had a tumor diameter >5 cm. Disease stage was I, II, and III in 9%, 36%, and 38% of patients, respectively. 17% had recurrent NSCLC. At a median follow-up of 29.3 months, median overall survival was 15.9 months, and 3-year survival 20.1%. No 90-day mortality was observed. Disease progression occurred in 30% of patients (n = 14), with a median time to relapse of 29.5 months for all stages. Isolated local recurrences were not observed. A multi-disciplinary clinical panel assessment found grade ≥3 toxicity in 38% of patients. 21% of all patients were scored as having ‘possible’ (n = 2) or ‘likely’ (n = 8) treatment-related deaths, at 5.2–18.2 months post-treatment. Pulmonary hemorrhage was observed in 15% of patients. There were no significant differences in dosimetric parameters between patients with or without grade ≥3 toxicity.

Conclusions

Unfit patients treated with this 12-fraction scheme achieved a median overall survival of 15.9 months, and 3-year survival of 20.1%. The incidence of fatal lung hemorrhage was similar to that reported after conventional radiotherapy in patients with endobronchial tumors.

Clinical trial identification

Our study was a retrospective study and has no trial protocol number.

Legal entity responsible for the study

N/A

Funding

N/A

Disclosure

M. Dahele, B. Slotman: The Department of Radiation Oncology of the VU University Medical Center has a research agreement with Varian Medical Systems. Honoraria and travel support received from Varian Medical Systems and from Brainlab. W. Verbakel: Honoraria and travel support received from Varian Medical Systems. S. Senan: The Department of Radiation Oncology of the VU University Medical Center has a research agreement with Varian Medical Systems. Honoraria and travel support received from Varian Medical Systems. All other authors have declared no conflicts of interest.