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Evaluation of a care path for patients with lung tumors and co-existing interstitial lung disease

Date

05 Apr 2019

Presenters

Merle Ronden-Kianoush

Citation

Annals of Oncology (2019) 30 (suppl_2): ii20-ii21. 10.1093/annonc/mdz066

Authors

M.I. Ronden-Kianoush1, E.J. Nossent2, C. Dickhoff3, S.F.M. Nijman2, I. Bahce4, S. Senan5, F.O.B. Spoelstra5

Author affiliations

  • 1 Pulmonology / Radiation Oncology, Vrije University Medical Centre (VUMC), 1081 HV - Amsterdam/NL
  • 2 Pulmonology, Vrije University Medical Centre (VUMC), Amsterdam/NL
  • 3 Surgery And Cardiothoracic Surgery, Vrije University Medical Centre (VUMC), 1081 HV - Amsterdam/NL
  • 4 Pulmonology, Vrije University Medical Centre (VUMC), 1081 HV - Amsterdam/NL
  • 5 Radiation Oncology, Vrije University Medical Centre (VUMC), 1081 HV - Amsterdam/NL
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Background

Patients with lung cancer and co-existing interstitial lung disease (ILD) are at increased risk of treatment-related toxicity after both surgery and radiotherapy. A care path was implemented at our institution for patients presenting to the lung tumor board with a possible ILD, and we report on our experience using this structured approach.

Methods

Since 2015, patients with possible lung cancer and ILD were referred to the general ILD clinic for assessment. In 2017, a dedicated ILD lung tumor board was established in order to facilitate quick assessment of treatment-related risks. An ethics-approved institutional database containing details of all these patients was accessed.

Results

24 patients with lung tumors and a co-existing ILD were identified (Table). The mean interval between referral to, and consultation at our ILD-board was 2 weeks. A prior diagnosis of ILD was available in 9 of 17 (53%) patients, but review led to a re-classification of the ILD subtype in 8 of the former. Treatments for lung cancer included radiotherapy alone (n = 14), surgery (n = 6), sequential chemoradiation (n = 3), and concurrent CRT followed by salvage surgery (n = 1). 6 patients developed progression of ILD after radiation; of these, 2 had received nintedanib during treatment. One patient died because of progressive ILD and in another 3 patients ILD-related deaths could not be excluded.

Conclusions

A dedicated care path for ILD patients resulted in a fast evaluation of lung cancer patients. A previous ILD-diagnosis was revised in a majority of patients, a process which can allow for a better understanding of treatment-related risks in different subgroups of ILD patients, and also assess the role of ILD-directed therapies.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

S. Senan: Grants, during the conduct of the study: ViewRay Inc.; Personal fees, outside the submitted work: Varian Medical Systems. All other authors have declared no conflicts of interest.

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