Curative-intent radiotherapy outcomes in NSCLC patients with severe/very severe COPD & lung fibrosis
Tang, C. Price, G. Mistry, H. Kennedy, Jason Pemberton, Laura S Woolf, David K Cobben, David Chan, Clara
Tang, C.
Price, G.
Mistry, H.
Kennedy, Jason
Pemberton, Laura S
Woolf, David K
Cobben, David
Chan, Clara
Citations
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Abstract
Purpose or Objective
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 thoracic
radiotherapy in these patients.
Material and Methods
A retrospective real world dataset of 587 NSCLC patients
with COPD and 34 with lung fibrosis treated with curativeintent
thoracic radiotherapy at The Christie NHS
Foundation Trust (Manchester, UK) from January 2015 to
December 2016 were analysed. COPD severity was graded
using Global Initiative for Chronic Obstructive Lung Disease
classification (GOLD I-IV), dependent on forced expiratory
volume in 1 second (FEV1). The primary endpoint was
overall-survival (OS). The longitudinal use of oxygen
therapy and Medical Research Council (MRC) dyspnoea
scores were evaluated in a patient subset. Demographic
and clinical characteristics, baseline lung function and
radiotherapy and dosimetric lung parameters were
evaluated for association with OS.
Results
The characteristics for the whole cohort are shown in table
1. 148 (25%) COPD patients received stereotactic ablative
body radiotherapy (SABR). Median OS was 20 months (95%
CI: 17-21) for GOLD I (mild COPD; n=194), 19 months (95%
CI 17-21) for GOLD II (moderate COPD; n=255) and 20
months for GOLD III/ IV (severe and very severe COPD;
n=138) patients, respectively (fig1A). FEV1 and GOLD
category did not correlate with OS (p≥0.05). Median OS
was significantly shorter for patients with lung fibrosis (12
months, 95% CI: 4-18) compared to patients without lung
fibrosis (21 months, 95% CI: 19-23); p<0.001 (fig1B).
Treatment type (fractionated radiotherapy worse
compared to SABR), larger tumour volume, higher
dosimetric lung parameters (mean dose, V20 and V5),
advanced tumour stage and squamous histology all
correlated with poor OS (p<0.05). MRC dyspnoea scores
and oxygen therapy data were available in 21 (62%) and 14
(41%) fibrosis patients and 92 (67%) and 40 (30%) GOLD III/
IV COPD patients, respectively. MRC dyspnoea scores were
not significantly different before and after radiotherapy in fibrosis and GOLD III/ IV patients (p≥0.05). Oxygen therapy
increased after radiotherapy in GOLD III/ IV patients (n=12
before vs n=28 after) and in fibrosis patients (n=4 before
vs n=10 after). NSCLC patients with lung fibrosis have poor OS after
curative-intent thoracic radiotherapy. FEV1 and COPD
severity scores are not prognosticators and should not be
considered absolute contraindications for curative-intent
thoracic radiotherapy in NSCLC patients. Prospective
studies with functional and quality of life assessments are
needed to further refine radiotherapy treatment in these
patients.
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Tang C, Price G, Mistry H, Kennedy J, Pemberton L, Woolf D, et al. OC-0228: Curative-intent radiotherapy outcomes in NSCLC patients with severe/very severe COPD & lung fibrosis. Radiotherapy and Oncology . 2020 Nov;152:S117.