Radiation Considered Safe in Unbiopsied Lung Cancer

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A new study shows that treating patients with tereotactic body radiation for suspected, but not biopsied, lung cancers seems to enabel suitable local control of the disease with low toxicity.

"We achieved crude local control of lung cancer in 97.1% of our patients," said assistant professor of radiation oncology at the Loyola University Chicago Stritch School of Medicine, in his oral presentation, Matthew Harkenrider.

"The estimated 2-year regional control is 80%; distant control is 85%, and overall survival is 85% in 16.7 months of median follow-up," Harkenrider said at the annual meeting of the Radiological Society of North America (RSNA).

The RSNA meeting is the largest medical meeting in the U.S., with an expected attendance of more than 50,000 doctors, radiologists and allied healthcare professionals that enage in all the latest medical imaging developments and innovations worldwide.

"About 15% of non-small-cell lung cancer is localized to the lung at diagnosis and can be controlled by sublobar dissection. However, when sublobar dissection can't be performed without wedge dissection or segmentectomy, the local control is inferior to lobectomy. Lung cancer patients also have chronic obstructive lung disease, vascular disease and other comorbidities that preclude surgical management. In these cases, stereotactic body radiation therapy has been used as the preferred treatment management for these patients. Some patients have radiological evidence of tumors but cannot tolerate the biopsy procedure; others have undergone unsuccessful biopsy. The goal of the study was to investigate outcomes among this population,” explained Harkenrider.Radiation Safe in Unbiopsied Lung Cancer

The study was conducted at the University of Virginia and at the University of Louisville where it restrospectively analyzed patients treated with stereotactic body radiation therapy without a biopsy. Not one of the patients had nodal disease and there was no indication of metastases at baseline. However, they did have radiographic imaging that was constant with lung cancer.

The researchers registered 34 patients, 17 from each of the participating institutions. They receivedpretreatment imaging with CT and PET/CT scans; and were then treated with a standard radiation dose of 50 Gy, in a median of 5 fractions. All patients underwent additional CT scans 6 to 8 weeks following the preliminary stereotactic body radiation procedure, and then every 3 to 6 months afterward.

Average age of the patients in the study was 76 years; the patients had an Eastern Cooperative Oncology Group Performance Status of 0-1; most patients expressed a sullied lung performance. Nineteen of the 34 patients did not have a biopsy because of their chronic obstructive lung disease or pneumothorax; while another eight patients had cardiac disease that ruled out the stress of performing a biopsy, noted Harkenrider.

He also mentioed that acute toxicity of the radiation therapy was well-tolerated by the study patients. No grade 3 or greater toxicities were noted; three late grade 3 dyspneas were treated.

"We had only one local failure in these patients. The majority of the patients had stable lesions on follow-up.”

"This concern of whether we are really treating cancer can always occur when there is no biopsy. But we have imaging follow-ups in these patients. We see these lesions enlarge. We feel quite comfortable in treating these cases. We are actually treating more and more of those tumors in these cases,” said session moderator Zhongxing Liao, MD, of the University of Texas MD Anderson Cancer Center in Houston.

“The concern over whether patients actually do have cancer "also depends upon what area of the country you are treating patients. In the South, where most of these patients lived, there is endemic granulomatous lung disease," which can mimic lung cancer nodules on scans. However, he noted, this study's results are in line with findings in areas where there are populations without the concern for granulomatous lung disease,” Harkenrider said in response.

"To our knowledge, this is the first U.S. series to solely report outcomes for these patients. Standard of care for medically inoperable, early stage lung cancer patients remains to obtain pathologic diagnosis prior to treatment," he conluded.

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