(P104) Esophagus- and Contralateral Lung–Sparing IMRT for Locally Advanced Lung Cancer in the Community Hospital Setting

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OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

These data provide proof of principle that suboptimal radiation dose distributions are associated with significant acute and late lung and esophageal toxicity that may result in hospitalization or even premature mortality. We propose a relatively simple four-field IMRT technique with strict attention to commonly accepted lung and esophageal dose-volume constraints as a preferred approach for the majority of locally advanced lung cancers.

Johnny Kao, MD, Jeffrey Pettit, MS, Shanata S. Ramsaran, Terry Palatt, MD; Good Samaritan Hospital Medical Center

INTRODUCTION: The optimal technique for performing lung intensity-modulated radiation therapy (IMRT) remains poorly defined. Due to concerns regarding acute and late toxicity, the potential benefit of dose escalation beyond 60 Gy has not been established. We hypothesize that improved dose distributions associated with normal tissue-sparing IMRT can allow for safe dose escalation that will translate into decreased acute and late toxicity.

MATERIALS AND METHODS: We performed a retrospective analysis of 82 consecutive patients with stage II/III or stage IV lung cancer with a single distant metastasis (median age: 69 yr, 53% male, 21% small-cell lung cancer, 83% white, 70% Eastern Cooperative Oncology Group [ECOG] performance status score 0 or 1, 13% stage IV, and 87% receiving concurrent chemotherapy) treated from January 2010 to September 2014. From January 2010 to April 2012 (cohort A), patients were treated with the community standard of predominantly three-dimensional conformal radiotherapy (76%) without specific esophagus or lung constraints. From May 2012 to September 2014 (cohort B), patients were treated with predominantly IMRT (95%) while selectively sparing uninvolved lung and esophagus. The study endpoints were dosimetry, toxicity, and overall survival (OS).

RESULTS: Despite higher mean prescribed radiation doses in cohort B (64.5 Gy ± standard deviation [SD] 5.0 vs 60.8 Gy ± SD 6.2; P = .04), patients in cohort B had significantly lower lung V20, V10, V5, mean lung, maximum esophagus, and mean esophagus doses (P ≤.001). Mean lung V20 was 23.3 Gy ± SD 7.2 in cohort B vs 32.2 Gy ± SD 11.6 for cohort A. Mean esophagus dose was 20.2 Gy ± SD 10.2 in cohort B vs 34.3 Gy ± SD 12.7 for cohort A (P = .001). Patients in cohort B had reduced acute grade ≥ 3 esophagitis (0% vs 11%; P < .001) and late grade ≥ 2 pneumonitis (5% vs 21%; P = .01). The incidence of hospitalization for dehydration and/or pulmonary complaints was 11% for cohort B vs 37% for cohort A (P = .008). Three patients in cohort A who developed grade 5 pneumonitis had lung V20 values of 41%, 48%, and 58% and lung V5 values of 90%, 99%, and 88%, respectively. Median survival in cohort B has not been reached at 24 months vs 13 months for cohort A (P = .13).

CONCLUSION: These data provide proof of principle that suboptimal radiation dose distributions are associated with significant acute and late lung and esophageal toxicity that may result in hospitalization or even premature mortality. We propose a relatively simple four-field IMRT technique with strict attention to commonly accepted lung and esophageal dose-volume constraints as a preferred approach for the majority of locally advanced lung cancers.

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis

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