(P059) Increased Rates of Radiation Pneumonitis in Patients Receiving Stereotactic Ablative Radiotherapy for Central Versus Peripheral Lung Tumors

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Article
OncologyOncology Vol 28 No 1S
Volume 28
Issue 1S

Treatment of central lung tumors with stereotactic ablative radiotherapy (SABR) has been associated with higher rates of toxicities than in patients with peripheral tumors. Here, we report our institution’s experience in treating central lung tumor patients with SABR, compared with patients treated for peripheral lung tumors.

Aadel A. Chaudhuri, MD, PhD, Chad Tang, MD, Nicholas Trakul, MD, PhD, Jacob Wynne, BS, Billy W. Loo, MD, PhD, Maximilian Diehn, MD, PhD; Stanford University School of Medicine

Purpose: Treatment of central lung tumors with stereotactic ablative radiotherapy (SABR) has been associated with higher rates of toxicities than in patients with peripheral tumors. Here, we report our institution’s experience in treating central lung tumor patients with SABR, compared with patients treated for peripheral lung tumors.

Methods: We retrospectively reviewed outcomes in 85 patients with a total of 99 primary or metastatic lung tumors treated by SABR. The cohort included 49 central and 50 peripheral tumors, and all were treated with 50 Gy in 4–5 fractions. Outcomes and radiation-associated toxicities were compared between the two groups, not including patients in whom central and peripheral tumors were concurrently treated (eight such patients). Dosimetric analysis was performed on patients with central tumors to determine maximum point dose (MPD) and volumetric maximum dose (Vmax) to central structures.

Results: Median follow-up time was 15 months (range: 1–59 mo). Actuarial local control rate was 84% and 91% (P = .15) at 1 year for central and peripheral lesions, respectively. Median overall survival was 34 and 40 months (P = .55) for patients with central and peripheral tumors, respectively. We observed no hemoptysis and no grade 5 toxicities. Rates of symptomatic toxicity were higher in patients with central tumors (grade 2+, 38% vs 11%; P = .004) but were similar for severe toxicity (grade 3+, 7.7% vs 5.3%; P = .66). The majority of toxicities was due to radiation pneumonitis, the incidence of which was significantly greater in patients with central tumors (grade 2+, 28% vs 2.6%; P = .001; grade 3+, 7.7% vs 0%; P = .08). Dosimetric analysis of 37 central tumor treatment plans revealed that 25 (68%) exceeded at least one of the dose constraints used in Radiation Therapy Oncology Group (RTOG) 0813, most commonly for central airway and/or great vessels. Toxicity rates were similar in patients exceeding RTOG 0813 constraints compared with those meeting them (grade 2+, 32% vs 33%; P = .86).

Conclusion: Central lung tumor patients treated with SABR appear to have greater risk for radiation pneumonitis than patients with peripheral tumors. A subset of commonly used dosimetric constraints for lung SABR, particularly those for central airway and great vessels, may be more conservative than necessary.

Articles in this issue

(P113) Age and Marital Status Are Associated With Choice of Mastectomy in Patients Eligible for Breast Conservation Therapy
(P112) Single-Institution Experience With Intrabeam IORT for Treatment of Early-Stage Breast Cancer
(P110) Breast Cancer Before Age 40: Current Patterns in Clinical Presentation and Local Management
(P111) Accelerated Partial-Breast Irradiation With Multicatheter High-Dose-Rate Brachytherapy: Feasibility and Results in a Private Practice Cohort
(P115) Breast Cancer Laterality Does Not Influence Overall Survival in a Large Modern Cohort: Implications for Radiation-Related Cardiac Mortality
(P117) Anatomical Variations and Radiation Technique for Breast Cancer
(P116) Bilateral Immediate DIEP Reconstruction and Postmastectomy Radiotherapy: Experience at a Tertiary Care Institution
(P118) Metadherin Overexpression Is Associated With Improved Locoregional Control After Mastectomy
(P119) Effect of Economic Environment on Use of Postlumpectomy Radiation Therapy for Stage I Breast Cancer
(P120) Immediate Versus Delayed Reconstruction After Mastectomy in the United States Medicare Breast Cancer Patient
(P121) Trend in Age and Racial Disparities in the Receipt of Postlumpectomy Radiation Therapy for Stage I Breast Cancer: 2004–2009
(P122) Streamlining Referring Physicians Orders With ‘Reflex Testing’ Significantly Decreases Time to Resolution for Abnormal Screening Mammograms
(P123) National Trends in the Local Management of Early-Stage Paget Disease of the Breast
(P124) Effect of Inhomogeneity on Cardiac and Lung Dose in Partial-Breast Irradiation Using HDR Brachytherapy
(P125) Breast Cancer Outcomes With Anthracycline-Based Chemotherapy for Residual Disease Burden After Full-Dose Neoadjuvant Chemotherapy and Surgery Followed by Radiation Treatment
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