Outcomes of curative-intent radiotherapy in patients with severe COPD or lung fibrosis
Coote, Joanna H Tang, C. Salem, Ahmed Bayman, Neil A Chan, Clara Cobben, David Faivre-Finn, Corinne Harris, Maggie A Hudson, Andrew M Pemberton, Laura S
Coote, Joanna H
Tang, C.
Salem, Ahmed
Bayman, Neil A
Chan, Clara
Cobben, David
Faivre-Finn, Corinne
Harris, Maggie A
Hudson, Andrew M
Pemberton, Laura S
Citations
Altmetric:
Abstract
Introduction: Management of inoperable non-small cell lung cancer
(NSCLC) patients with severe chronic obstructive pulmonary disease
(COPD) and lung fibrosis is complex. We investigated outcomes of
curative-intent radiotherapy in these patients.
Methods: 587 NSCLC patients with COPD and 34 with lung
fibrosis treated with curative-intent radiotherapy at The Christie
NHS Foundation Trust from January 2015 -December 2016 were
evaluated. COPD severity was stratified using Global Initiative for
Chronic Obstructive Lung Disease (GOLD) classification (GOLD I–IV).
Primary end-point was overall-survival (OS). Clinical characteristics,
baseline lung function, radiotherapy and dosimetric lung parameters
(mean lung dose, V20 and V5 (volume receiving 20 and 5 Gray))
were evaluated for association with OS.
Results: 148 (25%) patients received stereotactic ablative body
radiotherapy (SABR). Median OS was 21 months (95% confidence
interval (CI) 19–23 months), 20 months (95% CI 18-22 months)
and 12 months (95% CI 4–18 months) for overall cohort, patients
with GOLD III/IV and lung fibrosis respectively. Difference in OS for fibrosis/non-fibrosis patients was significant (p<0.001). FEV1 and
GOLD category did not correlate with OS (p≥0.05). Treatment type,
tumour volume, dosimetric parameters, tumour stage and histology
all correlated with OS; smoking status did not. MRC dyspnoea scores
remained stable before (median 4, 95% CI 3–4 and median 4, 95% CI
4–4) and after (median 4, 95% CI 4–5; p≥0.05 and median 4, 95% CI
4–4; p≥0.05) radiotherapy in fibrosis (n=21) and GOLD III/IV patients
(n=92), respectively. Oxygen use increased after radiotherapy
in GOLD III/IV patients (n=12 vs n=28; p<0.05) but not in fibrosis
patients (n=4 vs n=10; p≥0.05).
Conclusion: Patients with lung fibrosis have poor OS after
radiotherapy. FEV1 is not a good predictor of outcomes after
curative-intent radiotherapy. Longer follow up with functional
status data would improve understanding of long term outcomes
and predictive factors in these patients.
Affiliation
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Coote JH, Tang C, Salem A, Bayman NA, Chan C, Cobben D, et al. Outcomes of curative-intent radiotherapy in patients with severe COPD or lung fibrosis. Lung Cancer. 2020;139:S32-S