Abstract 217P
Background
Lung cancer with vascular invasion (VI) into major vessels is associated with poor prognosis and risk of broncho-pulmonary hemorrhage. Evidence regarding safety and efficacy of curative intent radiotherapy is limited. We assessed outcomes and toxicity in patients with VI treated with curative intent (chemo)radiotherapy using established VI classifications.
Methods
We retrospectively analysed 45 patients with stage I–III lung cancer and documented VI via the electronic patient record between 06/19-06/23. 3 radiologists graded VI using the Han (2014) and Ma (2023) classifications. Overall survival (OS) and prognostic accuracy of VI classifications were analysed using Kaplan Meier and Cox hazards models.
Results
The table summarises patients and tumour characteristics. Radiological review revealed 7 patients did not have VI under either classifications. Median follow-up was 17.8 months (95% CI=11.2–20.8). Median OS was 32.6 months (95% CI=16.4–not reached), 31.2 months (95% CI=11.2 – not reached) and 19.4 months (95% CI=10.8 – not reached) for the whole cohort, Grade 0 and Grade 1+ respectively. Neither classification significantly stratified survival (p=0.07). Hazard ratios of death per unit increase in VI grade were 1.40 (95% CI=0.93–2.12) for Ma and 1.27 (95% CI=1.02–1.58) for Han. No Grade 5 pulmonary hemorrhage occurred. 2 patients (4.4%) died within 3 months of radiotherapy due to disease progression.
Table 217PSummary of demographics, treatment information and vessel involvement
| Demographics | n=45 |
| Median Age (IQR) | 72.0 (63.0–87.0) |
| Male | 24 (53.3%) |
| Female | 21 (46.7%) |
| TNM Staging | |
| Stage 1 | 7 (15.6%) |
| Stage 2 | 5 (11.1%) |
| Stage 3 | 33 (73.3%) |
| Treatment | |
| Radiotherapy alone | 27 (60.0%) |
| Sequential Chemoradiotherapy | 9 (20.0%) |
| Concurrent Chemoradiotherapy | 9 (20.0%) |
| Grading of Invasion | |
| Han (2014) | |
| G0 | 7 (15.6%) |
| G1 | 18 (40.0%) |
| G2 | 5 (11.1%) |
| G3 | 6 (13.3%) |
| G4 | 3 (6.7%) |
| G5 | 6 (13.3%) |
| Ma (2023) | |
| G0 | 7 (15.6%) |
| G1 | 23 (51.1%) |
| G2 | 9 (20.0%) |
| G3 | 6 (13.3%) |
Conclusions
Curative intent (chemo)radiotherapy in patients with VI was not associated with treatment-related deaths, even in high VI grades. The established VI classifications lacked prognostic value in this small cohort. Refinement of classification systems are needed to improve decision making for patients and clinicians.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.