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Abstract: Poster Presentations |

RADICAL ROBOTIC RADIOSURGERY FOR INOPERABLE PATIENTS WITH PERIPHERAL STAGE IA NON-SMALL CELL LUNG CANCER: PRELIMINARY LUNG FUNCTION AND SURVIVAL OUTCOMES FREE TO VIEW

Eric D. Anderson, MD*; Sean P. Collins, MD; Kelly Erickson, BS; Gregory Gagnon, MD; Shadi Yousefi, MD; Carlos Jamis-Dow, MD; Karun Sharma, MD; Filip Banovac, MD; Robin Gross, MD; Cristina A. Reichner, MD; Brian T. Collins, MD
Author and Funding Information

Georgetown University, Washington, DC


Chest


Chest. 2008;134(4_MeetingAbstracts):p158002. doi:10.1378/chest.134.4_MeetingAbstracts.p158002
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Abstract

PURPOSE: To report early lung function and survival outcomes following radical robotic radiosurgery for inoperable peripheral stage IA non-small cell lung cancer (NSCLC) patients.

METHODS: Inoperable patients with biopsy-proven peripheral stage IA NSCLC were enrolled. Total doses ranging from 42 to 60 Gray (Gy) were prescribed. The 30-Gy isodose contour was extended at least 1 cm from the tumor to eradicate microscopic disease. Treatment was delivered in 3 equal fractions over a 2 week period using the CyberKnife. Routine pulmonary function tests were completed at 1 year.

RESULTS: Twenty predominately former smokers (90%) with a mean age of 75 years and an average maximum tumor diameter of 2.2 cm (range, 1.4 - 3.0 cm) were treated. The mean baseline forced expiratory volume in 1 second (FEV1) was 1.06 L or 54% predicted (range, 21 - 84%). The mean baseline diffusion capacity for carbon monoxide (DLCO) was 11.0 mg/min/mmHg or 58% predicted (range, 47 - 83%). An average total dose of 53 Gy was delivered to the 5 mm tumor margin, resulting in 7.3% of the mean total lung volume receiving a potentially injurious dose of 15 Gy or more (range, 2.4% to 11.3%). The mean percent predicted DLCO declined by 11% (range, 0 to 33%) at 1 year. At a median follow-up of 30 months, 17 patients remain alive without evidence of disease. Deaths at 9, 18 and 24 months were the result of progressive lung dysfunction in patients with pretreatment FEV1 values less than 30% predicted.

CONCLUSION: Radical robotic radiosurgery results in exceptional tumor control and survival in inoperable patients with peripheral stage IA NSCLC. However, survival remains disappointing in patients with very severe COPD.

CLINICAL IMPLICATIONS: Optimizing survival outcomes in patients with peripheral stage IA NSCLC and very severe COPD (FEV1<30% predicted) may require more conservative CyberKnife treatment approaches.

DISCLOSURE: Eric Anderson, Consultant fee, speaker bureau, advisory committee, etc. Honoraria for educational lectures from Accuray.; No Product/Research Disclosure Information

Wednesday, October 29, 2008

1:00 PM - 2:15 PM


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