SESSION TITLE: Lung Cancer I
SESSION TYPE: Slide Presentations
PRESENTED ON: Saturday, March 22, 2014 at 02:15 PM - 03:45 PM
PURPOSE: To report the pneumothorax rate following fiducial placement for peripheral inoperable stage I non-small cell lung cancer (NSCLC) who undergo stereotactic body radiation therapy (SBRT).
METHODS: Inoperable patients with biopsy-proven stage I NSCLC (AJCC 7th edition) measuring 5 - cm or less in maximum diameter were evaluated. Three-to-five gold fiducial markers were implanted in or near tumors to serve as targeting references percutaneously under CT guidance or utilizing electromagnetic navigational bronchoscopy. Plain chest films were routinely completed immediately following fiducial placement. The number of patients who developed a pneumothorax and required chest tube placement was recorded. Full pulmonary function tests were completed just prior to treatment and at one year follow-up.
RESULTS: Forty patients (median age 76) with a median percent predicted FEV1 of 64% (range, 21 - 100%) and a median percent predicted DLCO of 52% (range, 33 -102%) were treated. Twenty-one patients had fiducials placed percutaneously under CT guidance; 19 patients had fiducials placed using electromagnetic navigational bronchoscopy. The rate of pneumothorax requiring chest tube insertion was 38% with percutaneous placement. No pneumothoracies were observed following electromagnetic navigational bronchosocpy. At median follow-up of 46 months, the 3-year Kaplan-Meier locoregional control and overall survival estimates were 95% and 73%. There was no change in percent predicted FEV1 one year following SBRT; there was a small but statistically significant 8% decline in percent predicted DLCO at one year.
CONCLUSIONS: SBRT with fiducial tracking is a well tolerated effective treatment for peripheral stage I NSCLC. The adoption of electromagnetic navigational bronchoscopic fiducial placement reduces the risk of developing a pneumothorax.
CLINICAL IMPLICATIONS: Fiducial tracking improves SBRT treatment accuracy and therefore decreases permanent radiation induced lung damage. However, fiducial placement has historically resulted in high pneumothrax rates hampering its broad adoption. Electromagnetic navigational bronchoscopic fiducial placement reduces this risk.
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: Shaan Kataria, Ryan Malik, Catherine Jamis, Leonard Chen, Simeng Suy, Cristina Reichner, Eric Anderson
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