Abstract
Purpose/Objective:
Stereotactic body radiotherapy (SBRT) is a valuable treatment option in medically inoperable early stage lung cancer patients. The most common reason for inoperability is reduced pulmonary function. The toxicity profile of SBRT has been shown to be favourable in these patients. However, there is lack of data reporting a threshold of pre-treatment pulmonary function being safe for SBRT delivery. Therefore, the aim of the present study was to report on efficacy and safety of SBRT in patients with severe pulmonary restriction defined as FEV1 < 40%.
Material/Methods:
Twenty four patients with lung cancer treated between 12/2018 and 02/2022 were included into the analysis. Only 9/24 patients had histologic confirmation of non-small cell lung cancer due to tumour location and/or poor lung function. For non-biopsy proven patients, clinical criteria of malignancy were defined as hypermetabolism on PET-CT and growth on sequential computed tomography. All patients showed a pulmonary baseline function FEV1 <40%. An ITV approach using all respiratory phases on 4D-CT was used for target delineation. Treatment was delivered using VMAT-SBRT technique with 54 Gy in 3 fractions, 50 Gy in 10 fractions or 60 Gy in 8 fractions depending on tumour size and location. The toxicity was scored according to CTCAE v5.0 at baseline, end of treatment and every 3 months thereafter for the next two years, followed by 6 months intervals for the next 3 years. Dyspnoea and cough were evaluated separately.
Results:
The cohort mainly consisted of elderly patients (mean age 69, 56-82) with severe comorbidities, with a mean Charlson comorbidity index of 7 (4-15). Mean FEV1 was 29,3% (39,9-16%) and 0,86l (1,39-0,37l). The mean diameter of treated lesions was 24,9mm (9-48mm).
2 year-OS was 62% with a median follow-up of 25 months (8-48 months). The median follow up for local control and toxicity was 13 Months (3-45 Months). The estimated 2-Year local control rate was 96%.
Toxicity was overall low. At baseline before therapy dyspnoea grade 1/2/3 was reported in 28%/56%/16% of patients. The respective rates were 23%/53%/23% at 1 year following after therapy. No grade 4 or 5 toxicity were reported. Cough was reported at baseline with grade 1/2 /3 by 44%/20/0% of all patients, and at 1 year with 10%/0%,0% respectively. In the per patients analysis none of the patients showed clinically significant increase of toxicity.
Conclusion:
In this patient cohort, SBRT has proven to be a safe and effective treatment option in patients with severely reduced pulmonary function. Longer follow up and a larger patient population are needed to validate these findings.
Stereotactic body radiotherapy (SBRT) is a valuable treatment option in medically inoperable early stage lung cancer patients. The most common reason for inoperability is reduced pulmonary function. The toxicity profile of SBRT has been shown to be favourable in these patients. However, there is lack of data reporting a threshold of pre-treatment pulmonary function being safe for SBRT delivery. Therefore, the aim of the present study was to report on efficacy and safety of SBRT in patients with severe pulmonary restriction defined as FEV1 < 40%.
Material/Methods:
Twenty four patients with lung cancer treated between 12/2018 and 02/2022 were included into the analysis. Only 9/24 patients had histologic confirmation of non-small cell lung cancer due to tumour location and/or poor lung function. For non-biopsy proven patients, clinical criteria of malignancy were defined as hypermetabolism on PET-CT and growth on sequential computed tomography. All patients showed a pulmonary baseline function FEV1 <40%. An ITV approach using all respiratory phases on 4D-CT was used for target delineation. Treatment was delivered using VMAT-SBRT technique with 54 Gy in 3 fractions, 50 Gy in 10 fractions or 60 Gy in 8 fractions depending on tumour size and location. The toxicity was scored according to CTCAE v5.0 at baseline, end of treatment and every 3 months thereafter for the next two years, followed by 6 months intervals for the next 3 years. Dyspnoea and cough were evaluated separately.
Results:
The cohort mainly consisted of elderly patients (mean age 69, 56-82) with severe comorbidities, with a mean Charlson comorbidity index of 7 (4-15). Mean FEV1 was 29,3% (39,9-16%) and 0,86l (1,39-0,37l). The mean diameter of treated lesions was 24,9mm (9-48mm).
2 year-OS was 62% with a median follow-up of 25 months (8-48 months). The median follow up for local control and toxicity was 13 Months (3-45 Months). The estimated 2-Year local control rate was 96%.
Toxicity was overall low. At baseline before therapy dyspnoea grade 1/2/3 was reported in 28%/56%/16% of patients. The respective rates were 23%/53%/23% at 1 year following after therapy. No grade 4 or 5 toxicity were reported. Cough was reported at baseline with grade 1/2 /3 by 44%/20/0% of all patients, and at 1 year with 10%/0%,0% respectively. In the per patients analysis none of the patients showed clinically significant increase of toxicity.
Conclusion:
In this patient cohort, SBRT has proven to be a safe and effective treatment option in patients with severely reduced pulmonary function. Longer follow up and a larger patient population are needed to validate these findings.
| Translated title of the contribution | Sicherheit und Effektivität der stereotaktischen Lungenbestrahlung bei Patienten mit stark reduzierter Lungenfunktion |
|---|---|
| Original language | English |
| Publication status | Published - 03 May 2024 |
| Event | ESTRO 2024 - Glasgow, Glasgow, United Kingdom Duration: 03 May 2024 → 07 May 2024 https://www.estro.org/Congresses/ESTRO-2024 |
Conference
| Conference | ESTRO 2024 |
|---|---|
| Country/Territory | United Kingdom |
| City | Glasgow |
| Period | 03.05.2024 → 07.05.2024 |
| Internet address |