Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
POSTER SESSION 2 – P2.05: RADIOTHERAPY
TOXICITIES –
TUESDAY, DECEMBER 6, 2016
P2.05-051 SAFETY OF LUNG STEREOTACTIC BODY RADIOTHERAPY
(SBRT): A SINGLE INSTITUTION PROSPECTIVE STUDY BASED ON
RTOG 0915 PROTOCOL CONSTRAINTS
Valentina Vanoni 1 , Anna Delana 2 , Andrea Martignano 2 , Salvatore Mussari 1 ,
Christine Seebacher 3 , Emanuela Vattemi 3 , Antonello Veccia 4 , Luigi Tomio 1
1 Radiotherapy, S. Chiara Hospital, Trento/Italy, 2 Medical Physics, S. Chiara Hospital,
Trento/Italy, 3 Pneumology, S. Maurizio Hospital, Bolzano/Italy, 4 Medical Oncology,
S. Chiara Hospital, Trento/Italy
Background: To evaluate toxicity of RTOG 0915 protocol’s constraints in lung
SBRT for patients treated with 60Gy in 5 fractions. Methods: Between 2010
and 2015, 77 pts were treated with SBRT for single or multiple lung lesions, 43
pts. (55.8%) for primary tumor and 34 pts. (44.2%) for metastatic lesion. A
total of 80 lesions were treated. Four dimensional CT images were acquired;
maximum intensity CT reconstruction was used for ITV delineation and
average CT reconstruction for OAR contouring and dosimetric calculation.We
prescribed 57Gy to 95% of PTV volume and OAR constraints are reported in
table 1.
March 2016. The date range for the non-SABR patients extended back to
January 1995, but the first 3D-CRT SABR papers assessed were found in 2003.
Results of these searches were filtered in accordance to a set of eligibility
criteria and analysed in accordance with the PRISMA Guidelines. Results:
Results: The systematic search yielded a total of 184 SABR and 360 non-SABR
articles, which were filtered down to 75 SABR and 23 non-SABR articles. SABR
patients were older than non-SABR patients with 35/75 SABR papers and 0/23
non-SABR papers recording a median age >75 years. Meta-analysis did not
demonstrate a significant difference in pneumonitis rates between patients
receiving SABR [11.4% ( 95% CI of 9.7 to 13.3)] and non-SABR treatment [14.4%
(95% CI of 10.6 to 18.8)]. Conclusion: Conclusion: Although meta-analysis did
not confirm that SABR had lower rates of pneumonitis, it appears that SABR
patients are older, and thus potentially frailer than the non-SABR radically
treated patients. SABR is safe and has justifiably become the treatment of
choice for inoperable patients.
Keywords: pneumonitis, Stereotactic ablative body radiotherapy
POSTER SESSION 2 – P2.05: RADIOTHERAPY
TOXICITIES –
TUESDAY, DECEMBER 6, 2016
P2.05-053 DISCUSSION AND ANALYSIS OF PNEUMONITIS RELATED
TO STEREOTACTIC RADIOTHERAPY IN OUR HOSPITAL
Keisuke Imasaka 1 , Eriko Ikeya 1 , Yuki Mitamura 1 , Manabu Toyoda 1 , Hiroki
Takakura 1 , Akio Komuro 1 , Koichi Sunada 1 , Nobuyuki Hamanaka 1 , Miki
Takahashi 1 , Kunihiko Shimizu 1 , Yoshimasa Inoue 2 , Teruhiro Aoki 2 , Shoji Sakai 2 ,
Kazuhito Funakoshi 3
1 Department of Respiratory Medicine, Saiseikai Yokohamashi Tobu Hospital,
Kanagawa/Japan, 2 Department of Thoracic Sugery, Saiseikai Yokohamashi
Tobu Hospital, Kanagawa/Japan, 3 Department of Radiation Therapy, Saiseikai
Yokohamashi Tobu Hospital, Kanagawa/Japan
Dose calculation was performed in 70% of the cases with collapsed cone
convolution algorithm and 7 fields 3D technique and the remaining 30% with
Monte Carlo dose calculation and intensity modulated fields (dynamic MLC
and VMAT tecniques). Treatments were delivered in 28% of the cases on
Elekta-Precise accelerator with electronic portal films on-line setup
verifications and the remaining 72% on Elekta-Agility accelerator with cone
beam CT. We evaluated pre-treatment respiratory function and we treated
only pts. with %FEV1 > 40%. We reported toxicity following CTCAE v3.0 score.
Results: All the dose/constraints were respected except for the chest wall
dose that was higher than 30 Gy in 8 pts. (10.3%). Toxicity was evaluated in all
the patients except one that was lost in follow-up. We found only lung or
chest wall toxicity: 11 pts. (14.2%) with a G2 dyspnea, one patient with a G3
dyspnea; 8 pts. with a G2 chest wall pain and 1 with a symptomatic rib fracture
. We find more lung toxicity in patients with primary tumor because of more
chronic lung disease prior to the treatment. Conclusion: The use of these SBRT
constraints is safe in both metastatic and primary lung lesions, with a
particular attention on pre-treatment respiratory function.
Keywords: SBRT, NSCLC, toxicity
POSTER SESSION 2 – P2.05: RADIOTHERAPY
TOXICITIES –
TUESDAY, DECEMBER 6, 2016
Background: Stereotactic radiotherapy (SRT) for lung tumors and related
pneumonitis have been increasing, associated with the widespread use
of SRT. However, insufficient research on pneumonitis related to SRT has
been reported. Therefore, we attempted to clarify the clinical features and
risk factors for pneumonitis. Methods: Between October 2011 and 2014, 91
patients received SRT for thoracic tumors in our hospital. We carried out
a retrospective analysis of their data based on medical records and chest
images, and we summarized the clinical features and the presence or absence
of pneumonitis. Results: Of 91 patients who received SRT, 62 (68.1%) were
men and 29 (31.9%) were women, with a median age of 77 years. Fiftyseven
(62.6%) patients were smokers and 34 (37.4%) were non-smokers.
Furthermore, 17 (18.7%) patients had pre-existing pulmonary fibrosis and
48 (52.7%) had pre-existing emphysema. The target diseases treated with
SRT were 62 cases of primary lung cancer and 29 cases of other diseases
(e.g., metastatic lung tumor). Pneumonitis related to SRT was observed in
74 cases (81.3%). Their grades (CTCAE version 4) were as follows: 54 (59.3%)
cases of grade 1, 15 (16.5%) cases of grade 2, 4 (4.4%) cases of grade 3, 1 (1.1%)
case of grade 4, and no cases of grade 5. Grade 2 or more severe pneumonitis
was significantly higher in patients who had pre-existing fibrosis (p=0.016).
Grade 3 or more severe pneumonitis, clinically serious, was observed in 5
cases (5.5%), of which 4 were men and 1 was a woman, and 4 were smokers. In
addition, 4 of them had both pre-existing fibrosis and emphysema. All were
treated with steroid therapy and improved. Conclusion: Pneumonitis related
to SRT, including mild cases, was observed frequently. Pre-existing pulmonary
fibrosis is suggested to be an independent risk factor for pneumonitis
caused by SRT, as well as by conventional radiotherapy. However, even severe
pneumonitis was improved by steroid therapy. These observations highlight
the importance of steroid therapy. We will analyze more cases, including
patients under observation, and will report these data at the venue.
Keywords: stereotactic radiotherapy, Radiation pneumonitis, steroid therapy,
pre-existing pulmonary fibrosis
P2.05-052 A SYSTEMATIC REVIEW AND META-ANALYSIS OF
PNEUMONITIS IN RADICALLY TREATED NSCLC PATIENTS: SABR. VS.
NON-SABR TREATMENT
Fiona Hegi-Johnson 1 , Maria Azzi 2 , Mario D’Souza 3
1 Radiation Physics Laboratory, University of Sydney, Sydney/Australia, 2 Central
Coast Cancer Care Centre, Gosford/NSW/Australia, 3 University of Sydney, Sydney/
Australia
Background: Purpose: SABR is popular because of the high rates of local
control seen in lung cancer patients. However, prospective head to head
trial data comparing the toxicity of SABR to conventionally fractionated
radiotherapy are still awaited. We compare pneumonitis rates in SABR vs.
non-SABR treatment for early stage lung cancer patients. Methods: Methods:
A PUBMED search of all human, English language papers on SABR and on-
SABR radically treated early stage lung cancer patients was performed until
POSTER SESSION 2 – P2.05: RADIOTHERAPY
TOXICITIES –
TUESDAY, DECEMBER 6, 2016
P2.05-054 RADIATION PNEUMONITIS; EARLY DIAGNOSIS AND
PROTEIN EXPRESSION PROFILE IN NSCLC PATIENTS
Samantha Aso 1 , Arturo Navarro-Martin 2 , Susana Padrones 3 , Felipe Cardenal 4 ,
Noelia Cubero 3 , Rosa Lopez-Lisbona 3 , Mª Dolores Arnaiz 5 , Ramon Palmero 4 ,
Ana Montes 6 , Ernest Nadal 4 , Maria Molina 3 , Jordi Dorca 1
1 Respiratory Department, Bellvitge Hospital, L’Hospitalet de Llobregat/Spain,
2 Radiation Oncology Department, Catalan Institute of Oncology -Ico Hospitalet,
Hospitalet Del Llobregat/Spain, 3 Respiratory Medicine, Bellvitge Hospital,
S558 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017