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48O TREATMENT OF MULTIPLE PRIMARY LUNG CANCERS (MLPC) WITH STEREOTACTIC ABLATIVE RADIOTHERAPY (SABR)
Lung Cancer 80 Suppl. 1 (2013) S22–S25 Contents lists available at SciVerse ScienceDirect
Lung Cancer journal homepage: www.elsevier.com/locate/lungcan
EARLY STAGE NON-SMALL CELL LUNG CANCER 48O TREATMENT OF MULTIPLE PRIMARY LUNG CANCERS (MLPC) WITH STEREOTACTIC ABLATIVE RADIOTHERAPY (SABR)
49O LUNG TRANSPLANTATION IN EARLY STAGE CARCINOMA OF THE EXPLANTED LUNG IS IT A CURE FOR THE CANCER?
G.H.M.J. Griffioen1, F.J. Lagerwaard1 , C.J.A. Haasbeek1 , E.F. Smit2 , B.J. Slotman1 , S. Senan1 1 Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands, 2 Pulmonary Diseases, VU University Medical Center, Amsterdam, Netherlands
T. Klikovits, M.A. Hoda, B. Ghanim, S. Zgud, G. Murak¨ ozy, W. Klepetko, P. Jaksch Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
Introduction: Multiple primary lung cancers (MPLC) are not an uncommon clinical presentation. ESMO guidelines state that synchronously detected lesions should be treated as multiple primary tumors, and a curative approach for both lesions has been associated with improved survival in the surgical literature. However, many patients with MLCP are elderly and have multiple comorbidities, which can render them unfit for surgery to both lesions. We analyzed clinical outcomes in such patients treated with SABR. Methods: SABR was performed in 62 patients diagnosed with MPLC at the VUmc from 2003 2012. Staging included a mandatory FDGPET scan and all patients were discussed in a multi-disciplinary tumor board. A pathological diagnosis was available for both lesions in 3%, and for one lesion in 48%. SABR was a single modality for both lesions (N = 56) or in combination with surgery for the second lesion (N = 6). SABR was delivered to a total dose of 54 60 Gy in 3 8 fractions, depending on tumor size and location. Clinical outcome, including survival, pattern of relapse and toxicity (CTC v4.0) was evaluated. A sub-analysis was performed for ipsilateral and bilateral lung lesions. Results: Median overall survival was 31 months, with an actuarial survival of 40% at 3 years. Overall lesion local control was 78% at 3 years. Local control correlated significantly with tumor size (p = 0.005), number of fractions (p = 0.013) and lesion location (p = 0.004). Lesion control at 3 years for bilateral lesions was 92% versus 58% for ipsilateral lesions (p = 0.009). Regional- and distant failures were observed in 17% and 45%, respectively, at three years. No grade 3 early toxicity was observed. Late grade 3 toxicity was reported in 3 patients (5%), consisting of pneumonitis (n = 1), rib fracture (n = 1) and chest wall pain (n = 1). No grades 4 5 late toxicity was reported. Conclusion: Curative treatment of MPLC using SABR, alone or combined with surgery, can lead to long-term survival with limited toxicity. The disappointing local control rates observed after SABR for ipsilateral double lesions merits further investigation. The higher rate of nodal recurrences in patients presenting with multiple ipsilateral lesions suggests that invasive nodal staging may be required for such cases. Disclosure: G.H.M.J. Griffioen, F.J. Lagerwaard, C.J.A. Haasbeek, B.J. Slotman, S. Senan: The department of Radiation Oncology has a master research agreement with Varian medical systems. All other authors have declared no conflicts of interest.
0169-5002 /$
see front matter
Objective: The detection of cancer in a potential lung-transplantation (LuTX) recipient may be a contraindication for transplantation. We intend to report about our experience with incidence and survival of LuTX recipients and unknown pretransplant primary thoracic neoplasms. Methods: We retrospectively reviewed our database of 1262 patients that underwent LuTX between 1989 and 2012 at our institution. Results: The incidence of unexpected early stage thoracic tumors in this cohort was 1.03% (13 out of 1262). There were 8 men and 5 women with a mean age of 54.3±9.02 years who received 1 single-lung and 12 bilateral transplants. The indication for LuTX was chronic obstructive pulmonary disease (COPD) in 10 and pulmonary fibrosis in 2 patients. One patient suffered from cystic fibrosis. The posttransplant histological diagnosis of the explanted lung revealed adenocarcinoma in 6, squamous cell carcinoma in 3, bronchioloalveolar carcinoma in 2 cases, malignant epitheloid pleural mesothelioma (MPM) in 1 and carcinoid tumor in 1 case. The 2009 tumor node metastasis (TNM) staging revealed stage IA (pT1a/b N0) in 9 and IB (pT2a N0) in 2 cases. One patient was in stage IIA (pT1b N1). The patient with MPM was in IMIG/IASLC stage III and died on the eleventh postoperative day due to myocardial infarction. The patients with lung cancer underwent full posttransplant staging and no incidence of intrathoracic or distant metastasis was found. No adjuvant chemo- or radiotherapy was administered. Patients underwent regular positron emission tomography/computed tomography (PET/CT) check-ups and despite standard immunosuppression treatment at low levels no recurrence was detected at any time of follow-up. 5-year survival rate was 72%. Conclusions: Unexpected malignant lung tumors in explanted lungs at transplantation are rare, with an incidence of 1% in our population. In patients with early stage lung cancer lung transplantation with regular postoperative immunosuppression is a feasible treatment without any recurrence or influence on survival. Disclosure: All authors have declared no conflicts of interest.
Lung Cancer journal homepage: www.elsevier.com/locate/lungcan
EARLY STAGE NON-SMALL CELL LUNG CANCER 48O TREATMENT OF MULTIPLE PRIMARY LUNG CANCERS (MLPC) WITH STEREOTACTIC ABLATIVE RADIOTHERAPY (SABR)
49O LUNG TRANSPLANTATION IN EARLY STAGE CARCINOMA OF THE EXPLANTED LUNG IS IT A CURE FOR THE CANCER?
G.H.M.J. Griffioen1, F.J. Lagerwaard1 , C.J.A. Haasbeek1 , E.F. Smit2 , B.J. Slotman1 , S. Senan1 1 Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands, 2 Pulmonary Diseases, VU University Medical Center, Amsterdam, Netherlands
T. Klikovits, M.A. Hoda, B. Ghanim, S. Zgud, G. Murak¨ ozy, W. Klepetko, P. Jaksch Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
Introduction: Multiple primary lung cancers (MPLC) are not an uncommon clinical presentation. ESMO guidelines state that synchronously detected lesions should be treated as multiple primary tumors, and a curative approach for both lesions has been associated with improved survival in the surgical literature. However, many patients with MLCP are elderly and have multiple comorbidities, which can render them unfit for surgery to both lesions. We analyzed clinical outcomes in such patients treated with SABR. Methods: SABR was performed in 62 patients diagnosed with MPLC at the VUmc from 2003 2012. Staging included a mandatory FDGPET scan and all patients were discussed in a multi-disciplinary tumor board. A pathological diagnosis was available for both lesions in 3%, and for one lesion in 48%. SABR was a single modality for both lesions (N = 56) or in combination with surgery for the second lesion (N = 6). SABR was delivered to a total dose of 54 60 Gy in 3 8 fractions, depending on tumor size and location. Clinical outcome, including survival, pattern of relapse and toxicity (CTC v4.0) was evaluated. A sub-analysis was performed for ipsilateral and bilateral lung lesions. Results: Median overall survival was 31 months, with an actuarial survival of 40% at 3 years. Overall lesion local control was 78% at 3 years. Local control correlated significantly with tumor size (p = 0.005), number of fractions (p = 0.013) and lesion location (p = 0.004). Lesion control at 3 years for bilateral lesions was 92% versus 58% for ipsilateral lesions (p = 0.009). Regional- and distant failures were observed in 17% and 45%, respectively, at three years. No grade 3 early toxicity was observed. Late grade 3 toxicity was reported in 3 patients (5%), consisting of pneumonitis (n = 1), rib fracture (n = 1) and chest wall pain (n = 1). No grades 4 5 late toxicity was reported. Conclusion: Curative treatment of MPLC using SABR, alone or combined with surgery, can lead to long-term survival with limited toxicity. The disappointing local control rates observed after SABR for ipsilateral double lesions merits further investigation. The higher rate of nodal recurrences in patients presenting with multiple ipsilateral lesions suggests that invasive nodal staging may be required for such cases. Disclosure: G.H.M.J. Griffioen, F.J. Lagerwaard, C.J.A. Haasbeek, B.J. Slotman, S. Senan: The department of Radiation Oncology has a master research agreement with Varian medical systems. All other authors have declared no conflicts of interest.
0169-5002 /$
see front matter
Objective: The detection of cancer in a potential lung-transplantation (LuTX) recipient may be a contraindication for transplantation. We intend to report about our experience with incidence and survival of LuTX recipients and unknown pretransplant primary thoracic neoplasms. Methods: We retrospectively reviewed our database of 1262 patients that underwent LuTX between 1989 and 2012 at our institution. Results: The incidence of unexpected early stage thoracic tumors in this cohort was 1.03% (13 out of 1262). There were 8 men and 5 women with a mean age of 54.3±9.02 years who received 1 single-lung and 12 bilateral transplants. The indication for LuTX was chronic obstructive pulmonary disease (COPD) in 10 and pulmonary fibrosis in 2 patients. One patient suffered from cystic fibrosis. The posttransplant histological diagnosis of the explanted lung revealed adenocarcinoma in 6, squamous cell carcinoma in 3, bronchioloalveolar carcinoma in 2 cases, malignant epitheloid pleural mesothelioma (MPM) in 1 and carcinoid tumor in 1 case. The 2009 tumor node metastasis (TNM) staging revealed stage IA (pT1a/b N0) in 9 and IB (pT2a N0) in 2 cases. One patient was in stage IIA (pT1b N1). The patient with MPM was in IMIG/IASLC stage III and died on the eleventh postoperative day due to myocardial infarction. The patients with lung cancer underwent full posttransplant staging and no incidence of intrathoracic or distant metastasis was found. No adjuvant chemo- or radiotherapy was administered. Patients underwent regular positron emission tomography/computed tomography (PET/CT) check-ups and despite standard immunosuppression treatment at low levels no recurrence was detected at any time of follow-up. 5-year survival rate was 72%. Conclusions: Unexpected malignant lung tumors in explanted lungs at transplantation are rare, with an incidence of 1% in our population. In patients with early stage lung cancer lung transplantation with regular postoperative immunosuppression is a feasible treatment without any recurrence or influence on survival. Disclosure: All authors have declared no conflicts of interest.