Lung Cancer |

CyberKnife for Central Non-small Cell Lung Cancer (NSCLC) Conventional Radiation Failures FREE TO VIEW

Ryan Malik, MD; Shaan Kataria, MD; Catherine Jamis, BS; Leonard Chen, MD; Simeng Suy, PhD; Sean Collins, MD; Cristina Reichner, MD; Brian Collins, MD; Eric Anderson, MD
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MedStar Georgetown University Hospital - Divison of Pulmonary, Critical Care and Sleep Medicine, Washington, DC

Chest. 2014;145(3_MeetingAbstracts):346A. doi:10.1378/chest.1795891
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SESSION TYPE: Slide Presentations

PRESENTED ON: Saturday, March 22, 2014 at 02:15 PM - 03:45 PM

PURPOSE: To report local control and overall survival following CyberKnife treatment for central NSCLC conventional radiation failures.

METHODS: Patients presenting with recurrent central NSCLC within previously treated conventional radiation fields salvaged using the CyberKnife system with tumor tracking were retrospectively reviewed. Recurrences were considered central if they involved the supraclavicular fossa, mediastinum or hilum.

RESULTS: Twenty patients were treated over an 8-year period. Nine presented with mediastinal recurrence, eight with hilar recurrence, and three with an involved supraclavicular lymph node. Twelve patients had gold fiducials placed for tumor tracking via bronchoscopy; eight tumors were tracked using the spine as a reference structure. A cumulative dose of 25 to 45 Gy (median, 35 Gy) was delivered to the gross tumor volume in 5 fractions. At a median follow-up of 10 months, the 1-year Kaplan-Meier local control and overall survival estimates were poor at 36.6% and 52.7%, respectively. However, 1-year Kaplan-Meier local control and overall survival were improved at 76.2% and 87.5% when doses greater than 35 Gy were delivered. Two patients experienced grade II toxicity (brachial plexopathy and hemoptysis) following 45 Gy.

CONCLUSIONS: CyberKnife is a novel salvage treatment option for central NSCLC recurrence following conventional irradiation. Dose escalation resulted in improved local control and overall survival rates with acceptable toxicity.

CLINICAL IMPLICATIONS: Despite advances in the management of lung cancers, the rate of locoregional failure for patients with advanced NSCLC following conventional radiation remains high. The treatment options for these patients are limited. Because most are not surgical candidates, chemotherapy has remained the best salvage option, although this too has low response rates. In select patients, high dose salvage CyberKnife provides an effective, well-tolerated treatment option.

DISCLOSURE: Sean Collins: Consultant fee, speaker bureau, advisory committee, etc.: Consultant Accuray Inc. Brian Collins: Consultant fee, speaker bureau, advisory committee, etc.: Speaker Bureau Accuray Inc. The following authors have nothing to disclose: Ryan Malik, Shaan Kataria, Catherine Jamis, Leonard Chen, Simeng Suy, Cristina Reichner, Eric Anderson

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