117P - Feasibility of moderate hypofractionated image-guided thoracic irradiation for locally advanced node-positive non-small cell lung cancer patients with very limited lung function

Locally advanced NSCLC

117P - Feasibility of moderate hypofractionated image-guided thoracic irradiation for locally advanced node-positive non-small cell lung cancer patients with very limited lung function

Authors

Farkhad Manapov (DE)
Olarn Roengvoraphoj (DE)
Julian Taugner (DE)
Maurice Dantes (DE)
Cherylina Wijaya (DE)
Claus Belka (DE)
Chukwuka Eze (DE)

Presenter

Farkhad Manapov (DE)

Abstract

Abstract

Background

To determine the feasibility of moderate hypofractionated image-guided thoracic irradiation (Hypo-IGRT) in locally advanced node-positive non-small cell lung cancer patients with very limited pulmonary function.

Methods

Eight patients with NSCLC stage IIIA-C and highly diminished pulmonary function (FEV1 ≤ 1.0 L and/or DLCO-SB ≤ 40% and/or long-term oxygen therapy) were treated with Hypo-IGRT. Planning was based on 18F-FDG-PET/CT and 4-D computed tomography (4D-CT). GTV included primary tumor and involved lymph nodes (short-axis ≥1 cm and/or PET-positive). CTV was not generated. ITV was defined through the overlap of GTVs on 10 phases of 4D-CT. Isotropic margin of 5 mm was added to ITV to generate the PTV. Hypo-IGRT was delivered to a total dose of 45 Gy (ICRU) in 15 fractions under daily image-guidance.

Results

Eight patients completed Hypo-IGRT. The median follow-up was 20 months. The median age was 64 years. Two (25%), 4 (50%) and 2 (25%) patients presented with NSCLC stage IIIA, IIIB and IIIC, respectively. There were 7 (88%) patients with ECOG 2 and 1 (12%) patient with ECOG 3. Three patients received chemotherapy prior to Hypo-IGRT. Median initial DLCO-SB was 33.3% (range: 13.3–54) and the median initial FEV1 was 1L/39% predicted (range: 0.78–1.26L/28–60%). The median PTV was 226.9 cm³ (range: 100.17–379.80). The median overall survival (OS), progression-free survival (PFS) and distant metastasis-free survival (DMFS) for the entire cohort were not reached. Mean OS was 42 months (95% CI: 31.7–52.6). Mean PFS was 38 months (95% CI: 17.8–45.7). The 1- and 2-year OS rates were 100% and 87.5%. The 6- and 12- months PFS rates were 100% and 62.5%. Three patients developed local failure. Median mean lung dose was 9.4 Gy (range: 5.3–11.6). V15 and V20 for both lungs were 22% (range: 10–25) and 15% (range: 6–19). Median mean esophageal dose was 12.76 Gy (range: 2.1–26.7). There was no case of radiation pneumonitis. Four patients developed grade 2 acute radiation esophagitis.

Conclusions

This analysis shows that Hypo-IGRT can be considered in locally advanced node-positive NSCLC patients with very limited pulmonary function who are inadequate for conventional therapy.