Copenhagen, Denmark
Onsite/Online

ESTRO 2022

Session Item

Lung
6008
Poster (digital)
Clinical
Lung SBRT after pneumonectomy
Angela Botticella, France
PO-1246

Abstract

Lung SBRT after pneumonectomy
Authors:

Angela Botticella1, Antonin Levy1, Olaf Mercier2, Guillaume Auzac1, Aicha Traore-Diallo3, Maxime Frelaut4, Pauline Pradere2, Caroline Caramella5, Ines Kasraoui6, Benjamin Besse4, David Planchard4, C├ęcile Le Pechoux1

1Gustave Roussy, Radiation Oncology, Villejuif, France; 2Marie-Lannelongue Hospital, Thoracic and Vascular Surgery and Heart-Lung Transplantation Department, Plessis Robinson, France; 3Gustave Roussy , Radiation Oncology, Villejuif, France; 4Gustave Roussy, Oncology Department, Villejuif, France; 5Marie-Lannelongue Hospital, Radiology Department, Plessis Robinson, France; 6Gustave Roussy, Radiology Department, Villejuif, France

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Purpose or Objective

The objective of this retrospective study was to assess the efficacy and the safety of the SBRT in patients with prior pneumonectomy and a new lung malignancy.

Material and Methods

We retrospectively identified the patients who received SBRT post-pneumonectomy from a single institution database of patients treated with SBRT from January 2013 and June 2021.

Image-guided SBRT was delivered either with a Cyberknife or with a linear accelerator (in VMAT or with static coplanar beams). Lesions localised in the inferior lobes were treated using deep-inspiration breath-hold (DIBH).  The prescription dose was 26-60 Gy in 7.5- to 26-Gy fractions delivered to the PTV (according to a risk-adapted approach).

All patients underwent a restaging 18F-PET-CT scan before SBRT. A biopsy of the lung lesion was not mandatory, if the lesion was hyper-metabolic at a 18F-PET-CT scan and growing on multiple CT scans. Each patient was discussed in a multidisciplinary team before SBRT.

The primary endpoint was toxicity (lung, cardiac, oesophageal), graded using the Common Toxicity Criteria (CTC) v. 4.03. The secondary endpoints were local control, distant metastases-free survival and overall survival (OS). Dosimetric parameters were collected.

Results

Twenty-eight patients with prior pneumonectomy, treated with SBRT on 32 metastatic lesions, were identified. Median age was 62.3 years (range: 48-85). Twenty-four patients (86%) had a previous pneumonectomy for non-small cell lung cancer (NSCLC), 1 for a kidney cancer, 1 for a thymoma, 1 for a sarcoma and 1 for a colon cancer. The median time between pneumonectomy and SBRT was 70.34 months (SD: 143.16). Four patients had previous thoracic adjuvant radiotherapy, with doses ranging from 45 to 66 Gy in 20 to 33 fractions. Only one lesion was confirmed by biopsy. Median GTV was 4.06 mL (range: 0.39-110.65), median PTV was 16.32 mL (range: 3.6-231.35). Median MLD was 3 Gy (range: 0.27-13.27).

The median follow-up time was 28.9 months (SD: 11). No grade >3 toxicity was observed.

Twenty-one lesions (36.6%) were treated with static coplanar fields, 8 lesions (25%) were treated with VMAT and 2 lesions (6%) with static non-coplanar fields with a Cyberknife. Motion management was obtained in 18 lesions (56%) with a 4D-CT scan, in 12 lesions (37.5%) with DIBH and in 2 lesions with a tracking system (Cyberknife).

One local failure was registered. There were 2 regional failures and 10 distant failures. The median OS was 33.6 months (range: 3-73 months). The median OS was 33.6 months [CI95% : 2-73] and 1-, 2- and 5-years OS rates were respectively of 85%, 72% and 42%.

Conclusion

This study (the largest cohort to date) shows that local-control and long-term survival can be achieved with acceptable toxicity in this population with limited therapeutic options. An accurate motion management (with 40% of the lesions being treated with either DIBH or tracking) is mandatory.