Radical Radiotherapy For Lung Cancer Research Articles

3130: Impact of appropriate staging on radiotherapy planning for radical radiotherapy for lung cancer.

3130: Impact of appropriate staging on radiotherapy planning for radical radiotherapy for lung cancer.

The Prehabilitation Radiotherapy Exercise, smoking Habit cessation and Balanced diet Study (PREHABS) protocol to explore the feasibility of embedding behavioural modifications into the clinical pathway for patients undergoing radical radiotherapy for lung cancer

Patients with curable non-surgical lung cancer are often current smokers, have co-existing medical comorbidities and are treated with curative radiotherapy. To maximise the benefits of modern radiotherapy, there is an...

Clinicoradiological outcomes after radical radiotherapy for lung cancer in patients with interstitial lung disease.

Interstitial lung disease (ILD) is relatively common in patients with lung cancer with an incidence of 7.5%. Historically pre-existing ILD was a contraindication to radical radiotherapy owing to increased radiation pneumonitis rates, worsened fibrosis and poorer survival compared with non-ILD cohorts. Herein, the clinical and radiological toxicity outcomes of a contemporaneous cohort are described. Patients with ILD treated with radical radiotherapy for lung cancer at a regional cancer centre were collected prospectively. Radiotherapy planning, tumour characteristics, and pre- and post-treatment functional and radiological parameters were recorded. Cross-sectional images were independently assessed by two Consultant Thoracic Radiologists. Twenty-seven patients with co-existing ILD received radical radiotherapy from February 2009 to April 2019, with predominance of usual interstitial pneumonia subtype (52%). According to ILD-GAP scores, most patients were Stage I. After radiotherapy, localised (41%) or extensive (41%) progressive interstitial changes were noted for most patients yet dyspnoea scores (n = 15 available) and spirometry (n = 10 available) were stable. One-third of patients with ILD went on to receive long-term oxygen therapy, which was significantly more than the non-ILD cohort. Median survival trended towards being worse compared with non-ILD cases (17.8 vs 24.0 months, p = 0.834). Radiological progression of ILD and reduced survival were observed post-radiotherapy in this small cohort receiving lung cancer radiotherapy, although a matched functional decline was frequently absent. Although there is an excess of early deaths, long-term disease control is achievable. For selected patients with ILD, long-term lung cancer control without severely impacting respiratory function may be possible with radical radiotherapy, albeit with a slightly higher risk of death.

PO-1334 Breath hold for photon or proton therapy in radical radiotherapy for lung cancer: worth the effort?

PO-1334 Breath hold for photon or proton therapy in radical radiotherapy for lung cancer: worth the effort?

Radiomics for Predicting Lung Cancer Outcomes Following Radiotherapy: A Systematic Review

Lung cancer's radiomic phenotype may potentially inform clinical decision-making with respect to radical radiotherapy. At present there are no validated biomarkers available for the individualisation of radical radiotherapy in lung cancer and the mortality rate of this disease remains the highest of all other solid tumours. MEDLINE was searched using the terms ‘radiomics’ and ‘lung cancer’ according to the Preferred Reporting Items for Systematic Reviews and Met-Analyses (PRISMA) guidance. Radiomics studies were defined as those manuscripts describing the extraction and analysis of at least 10 quantifiable imaging features. Only those studies assessing disease control, survival or toxicity outcomes for patients with lung cancer following radical radiotherapy ± chemotherapy were included. Study titles and abstracts were reviewed by two independent reviewers. The Radiomics Quality Score was applied to the full text of included papers. Of 244 returned results, 44 studies met the eligibility criteria for inclusion. End points frequently reported were local (17%), regional (17%) and distant control (31%), overall survival (79%) and pulmonary toxicity (4%). Imaging features strongly associated with clinical outcomes include texture features belonging to the subclasses Gray level run length matrix, Gray level co-occurrence matrix and kurtosis. The median cohort size for model development was 100 (15–645); in the 11 studies with external validation in a separate independent population, the median cohort size was 84 (21–295). The median number of imaging features extracted was 184 (10–6538). The median Radiomics Quality Score was 11% (0–47). Patient-reported outcomes were not incorporated within any studies identified. No studies externally validated a radiomics signature in a registered prospective study. Imaging-derived indices attained through radiomic analyses could equip thoracic oncologists with biomarkers for treatment response, patterns of failure, normal tissue toxicity and survival in lung cancer. Based on routine scans, their non-invasive nature and cost-effectiveness are major advantages over conventional pathological assessment. Improved tools are required for the appraisal of radiomics studies, as significant barriers to clinical implementation remain, such as standardisation of input scan data, quality of reporting and external validation of signatures in randomised, interventional clinical trials.

Changes in the Management of Patients having Radical Radiotherapy for Lung Cancer during the First Wave of the COVID-19 Pandemic in the UK

AimsIn response to the COVID-19 pandemic, guidelines on reduced fractionation for patients treated with curative-intent radiotherapy were published, aimed at reducing the number of hospital attendances and potential exposure of vulnerable patients to minimise the risk of COVID-19 infection. We describe the changes that took place in the management of patients with stage I–III lung cancer from April to October 2020. Materials and methodsLung Radiotherapy during the COVID-19 Pandemic (COVID-RT Lung) is a prospective multicentre UK cohort study. The inclusion criteria were: patients with stage I–III lung cancer referred for and/or treated with radical radiotherapy between 2nd April and 2nd October 2020. Patients who had had a change in their management and those who continued with standard management were included. Data on demographics, COVID-19 diagnosis, diagnostic work-up, radiotherapy and systemic treatment were collected and reported as counts and percentages. Patient characteristics associated with a change in treatment were analysed using multivariable binary logistic regression. ResultsIn total, 1553 patients were included (median age 72 years, 49% female); 93 (12%) had a change to their diagnostic investigation and 528 (34%) had a change to their treatment from their centre's standard of care as a result of the COVID-19 pandemic. Age ≥70 years, male gender and stage III disease were associated with a change in treatment on multivariable analysis. Patients who had their treatment changed had a median of 15 fractions of radiotherapy compared with a median of 20 fractions in those who did not have their treatment changed. Low rates of COVID-19 infection were seen during or after radiotherapy, with only 21 patients (1.4%) developing the disease. ConclusionsThe COVID-19 pandemic resulted in changes to patient treatment in line with national recommendations. The main change was an increase in hypofractionation. Further work is ongoing to analyse the impact of these changes on patient outcomes.

150 - Clinical outcomes after radical radiotherapy for lung cancer in patients with interstitial lung disease

150 - Clinical outcomes after radical radiotherapy for lung cancer in patients with interstitial lung disease

Target Volume Dynamics During Radiation Therapy in Lung Cancer - Identifying the Window of Opportunity

To assess the dynamic changes in the target volume (TV) during the course of radical radiotherapy in Lung Cancer. We studied 83 consecutive patients with lung cancer treated with radical intent from January 2012 till December 2017.These patients received concurrent CTRT or Neoadjuvant Chemotherapy followed by Radiotherapy (RT) or RT alone. Radiotherapy was delivered to a total dose of 60-66Gy either with conventional fractionation or hypofractionation, using 3DCRT or IMRT technique. The gross tumor volume was contoured on the CBCTs and volume changes were computed from baseline planning scan for assessing the impact of treatment. Seventy-eight patients were found to be eligible for volume analysis (NSCLC = 69, SCLC = 9, CTRT = 38, NACT = 9, no chemotherapy = 31, conventional fractionation = 51, hypo fractionated RT = 27, 3DCRT = 38, IMRT = 40). The mean tumor volume at the beginning of radiotherapy was 105.62cc (range 4-689cc). The weekly mean percentage change in the volume of primary disease from pre-RT volume were 5.4% after week 1, 13.5% after week 2, 18.8% after week 3, 26.2% after week 4, 25.4% after week 5 and 31.5 % after week 6 (Pearson correlation coefficient - 0.607-1; moderate to strong relationship). Mean change in volume from week 1 to week 2 was 7.3%, week 2 to week 3 was 7.9%, week 3 to week 4 was 7.8%, week 4 to week 5 was 1% and week 5 to week 6 was 6.4 %. The weekly changes in volume with conventional fraction were 2.1%, 11%,17.2%,26.2%,25.3% and 31.5%, from week 1 till week 6; and with hypofractionation were 11.73%,17.63% and 23.87% from baseline till week 1, week 2 and after week 3 respectively. Weekly percentage changes seen with conventional fractionation were as follows: 8.4% for week 1-2; 7.2% for week 2-3; 7.8% for week 3-4; 1% for week 4-5 and 6.4% for week 5-6. For the entire cohort, at a median follow up of 36 months, 2-year overall survival (OS) rate was 65% and at 3-years was 56%. The 2-year PFS was 42% and 3 year was 30% with median PFS of 16 months. In patients with stable target volume, median PFS was 22 months compared to 14 months in patients with early volume reduction; early target increase and late decrease showed a similar PFS of 12 months (p value = 0.913, using log rank test). Also, patients with volume change at week 3 had statistically significant longer PFS compared to rest. Patients with a 20% volume change at week 4 had statistically significant longer OS. Patients with more than 10% and 30% volume change at week 4 had a trend towards better LRC (0.08) and OS (0.09) respectively. We observed that the maximum change in volume during treatment was seen at 3rd-4th week. This has implications, particularly for adaptive re-planning which may be done at mid treatment to reduce the doses delivered to normal tissue without compromising on the dose received by the target volume. We also observed significant correlation between various outcome parameters and volume changes during radiation for lung cancer.

Cardiovascular mortality and morbidity following radical radiotherapy for lung cancer: Is cardiovascular death under-reported?

BackgroundLung cancer is the most common malignancy worldwide. Radical radiotherapy is an essential treatment in the management of early and locally advanced lung cancer. Cardiac events are known to occur following radical radiotherapy for lung cancer. This study examines the burden of cardiac events post radiotherapy, and estimates the accuracy of death certification in patients who received radical radiotherapy for lung cancer. MethodsWe conducted a retrospective observational cohort study for all patients receiving radical radiotherapy for non-small cell lung cancer (NSCLC) at a large cancer centre between 01/01/2010 to 31/12/2016. Baseline cardiovascular disease and cancer status and treatment data were collected, along with hospital admission data and documented cause of death from the national registry for a median follow-up period of 34 months. ResultsOf 1224 patients included in the analysis, 378 (30.9%) patients had cardiovascular disease at baseline, including 140 (11.4%) with prior myocardial infarction. In the 846 patients without known cardiovascular disease, 451 (53.3%) had a QRISK2 predicted 10-year cardiovascular risk >20% over 10 years. During follow-up, 215 hospitalisations occurred (Incidence rate 6.2 per hundred patient years) which were classified as primarily cardiac, and 622 patients died (18 per 100 patient-years). However, death certificates stated a primary cardiac cause of death in only 33 cases (5.3% of deaths). Notably, 29% of patients dying out of hospital and certified as cancer death did not have documented cancer relapse prior to death, and 61% had no community palliative care input prior to death, implying these events may have been sudden and unexpected. ConclusionThere is a high prevalence of baseline cardiovascular disease in people undergoing radiotherapy for NSCLC, accompanied by significant rates of post-radiotherapy cardiovascular hospitalisation. However, only a small proportion of deaths are attributed to cardiovascular disease, together with the large amount of sudden deaths observed, this suggests that cardiovascular death is greatly under-reported in official statistics.

Cardiac toxicity of lung cancer radiotherapy.

Radical radiotherapy of lung cancer with dose escalation has been associated with increased tumor control. However, these attempts to continually improve local control through dose escalation, have met mixed results culminating in the findings of the RTOG trial 0617, where the heart dose was associated with a worse overall survival, indicating a significant contribution to radiation-induced cardiac morbidity. It is, therefore, very likely that poorly understood cardiac toxicity may have offset any potential improvement in overall survival derived from dose escalation and may be an obstacle that limits disease control and survival of patients. The manifestations of cardiac toxicity are relatively common after high dose radiotherapy of advanced lung cancers and are independently associated with both heart dose and baseline cardiac risk. Toxicity following the treatment may occur earlier than previously thought and, therefore, heart doses should be minimized. In patients with lung cancer, who not only receive substantial heart dose, but are also older with more comorbidities, all cardiac events have the potential to be clinically significant and life-threatening. Sophisticated radiation treatment planning techniques, charged particle therapy, and modern imaging methods in radiotherapy planning, may lead to reduction of the heart dose, which could potentially improve the clinical outcomes in patients with lung cancer. Efforts should be made to minimize heart radiation exposure whenever possible even at doses lower than those generally recommended. Heart doses should be limited as much as possible. A heart dosimetry as a whole is important for patient outcomes, rather than emphasizing just one parameter.

P1.17-22 Do Statins Improve Outcomes After Radical Radiotherapy for Lung Cancer? An In-Depth Analysis of Over 1100 Patients

P1.17-22 Do Statins Improve Outcomes After Radical Radiotherapy for Lung Cancer? An In-Depth Analysis of Over 1100 Patients

72O - Multi-centre analysis of cardiac events following radical radiotherapy for lung cancer

72O - Multi-centre analysis of cardiac events following radical radiotherapy for lung cancer

PO-0771 Cardiac event after radical radiotherapy for lung cancer - initial results from a multi-centre study

PO-0771 Cardiac event after radical radiotherapy for lung cancer - initial results from a multi-centre study

165 - Impact of radical radiotherapy in lung cancer – an assessment of cardiac and pulmonary volume changes in patients with locally advanced non-small cell lung cancer following radical radiotherapy

165 - Impact of radical radiotherapy in lung cancer – an assessment of cardiac and pulmonary volume changes in patients with locally advanced non-small cell lung cancer following radical radiotherapy

135: Re-plan rates for radical radiotherapy in lung cancer

135: Re-plan rates for radical radiotherapy in lung cancer

136: Reducing time to radical radiotherapy for lung cancer in Greater Manchester and East Cheshire

136: Reducing time to radical radiotherapy for lung cancer in Greater Manchester and East Cheshire

150 Ninety-day mortality following radical radiotherapy for lung cancer

150 Ninety-day mortality following radical radiotherapy for lung cancer

149 A review of the accuracy and efficacy of immobilisation used for patients receiving radical radiotherapy for lung cancer

149 A review of the accuracy and efficacy of immobilisation used for patients receiving radical radiotherapy for lung cancer

Predictors of Respiratory-induced Lung Tumour Motion Measured on Four-dimensional Computed Tomography

AimsThe delivery of radical radiotherapy in lung cancer is complicated by respiratory-induced tumour motion. The aim of the study was to correlate tumour motion characteristics with tumour and patient factors, particularly the anatomical lobe and pulmonary zone. Materials and methodsLung tumour volumes on four-dimensional computed tomography were delineated by a single observer at maximal expiration and propagated through all 10 phases of the breathing cycle. Movements were tracked in the superior–inferior (SI), anterior–posterior (AP) and medio-lateral (ML) directions by changes in the tumour centroid coordinates. Tumour motion characteristics were correlated with anatomical lobe, pulmonary zone, tumour volume, T-stage, smoking status and spirometry. ResultsIn 101 consecutive patients, the median magnitude of tumour motion in the SI direction was significantly larger in tumours located in lower lobes compared with upper lobes and middle/lingular lobes (0.70 cm versus 0.09 cm versus 0.26 cm, P < 0.01). No significant difference was found in median tumour motion between lower, upper and middle/lingular lobes in the AP (0.16 cm versus 0.13 cm versus 0.16 cm, P = 0.45) and ML (0.08 cm versus 0.08 cm versus 0.13 cm, P = 0.32) directions, respectively. When assessed by zone, the median tumour displacement in the SI direction was significantly larger in the lower zones (0.81 cm) as compared with the middle zones (0.30 cm) and upper zones (0.11 cm), P < 0.01. No difference was observed in the AP (P = 0.45) and ML (P = 0.73) directions. Tumour volume, T-stage and forced expiratory ratio were not statistically significant predictors of respiratory-induced tumour motion. ConclusionRespiratory-induced tumour motion in the SI direction was significantly greater in lower lobe and lower pulmonary zone tumours compared with apical tumours. Tumour volume, T-stage and spirometry did not correlate with the magnitude or direction of respiratory-induced tumour motion. During curative radiotherapy in lung cancer, attention should be paid to motion management, especially for lower lobe tumours.

PO-0988: Evaluation of set up margins and a correction protocol in radical radiotherapy for lung cancer

PO-0988: Evaluation of set up margins and a correction protocol in radical radiotherapy for lung cancer