Lung Cancer

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TU_29_3608 - Pulmonary Interstitial Lymphography and Patterns of Recurrence after Stereotactic Ablative Radiation Therapy(SABR) of Lung Tumors

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Pulmonary Interstitial Lymphography and Patterns of Recurrence after Stereotactic Ablative Radiation Therapy(SABR) of Lung Tumors
R. B. Ko1, J. A. Abelson1,2, N. Kothary3,4, D. Fleischmann5, L. Hofmann3,4, D. Hovsepian3, J. D. Louie3, G. Hwang3, D. Y. H. Sze3,4, K. Kielar1,6, P. G. Maxim1,4, Q. T. Le1,4, M. Diehn1,4, and B. W. Loo Jr1,4; 1Department of Radiation Oncology, Stanford University, Stanford, CA, 2Coastal Radiation Oncology, San Luis Obispo, CA, 3Department of Rad/Interventional Radiology, Stanford University, Stanford, CA, 4Stanford Cancer Institute, Stanford, CA, 5Department of Rad/Cardiovascular Imaging, Stanford University, Stanford, CA, 6Mills Peninsula Health Services, Burlingame, CA

Purpose/Objective(s): For patients treated with stereotactic ablative radiotherapy (SABR) for non-small cell lung cancer (NSCLC), we hypothesize that primary nodal drainage (PND) sites at highest risk for regional recurrence can be identified by CT-based pulmonary interstitial lymphography (PIL). We conducted a prospective pilot clinical trial of PIL to identify PND and analyzed patterns of recurrence through follow-up imaging.

Materials/Methods: Twelve patients with established or suspected malignant lung tumors underwent PIL during scheduled biopsy and/or fiducial marker placement procedures, by peritumoral injection of CT contrast. CT was obtained immediately prior to contrast injection (pre-PIL CT). Then, CT images were obtained at intervals up to 10 minutes after contrast injection (post-PIL CT) and contrast enhanced nodal regions were defined as PND. Eleven patients underwent SABR and one patient underwent chemoradiation. Sites of regional recurrence after radiation therapy were compared with sites of PND.

Results: Patient characteristics included a median age of 72 years (59-87 years), 6 males, 6 with primary tumor in the left lower lung, 3 with primary tumor in left upper lung, 1 with primary tumor in right lower lung, and 2 with primary tumor in the right upper lung. Contrast drainage was noted in all patients, and accumulated in defined nodal stations (the PND) in 7 patients. PND most frequently included ipsilateral hilar (6 of 7 patients) and ipsilateral mediastinal nodes (6 of 7 patients). 2 patients had local recurrence, 3 had distant metastases, and 3 had new primary tumors. Only 1 patient had nodal recurrence, in a mediastinal node. This patient had no PND identified at the time of PIL. One patient, who also had no PND identified at PIL, was found to have hilar nodal disease at the time of simulation for SABR and was instead treated with conventionally fractionated chemoradiation. Median follow-up was 35.5 months (7-75 months). There were no complications specifically related to PIL, although 6 patients (50%) experienced pneumothorax, 3 (25%) of which required a temporary chest tube.

Conclusion: This study demonstrates the feasibility of using pulmonary interstitial lymphography to identify primary nodal drainage in patients with lung tumors. Complications were as expected from transthoracic biopsy and/or fiducial marker placement. Nodal recurrence was uncommon in this small pilot cohort, and correlation with PIL will require a larger prospective study.

Author Disclosure: R.B. Ko: None. J.A. Abelson: None. N. Kothary: None. D. Fleischmann: None. G. Hwang: Employee; UCSF. D.Y. Sze: None. K. Kielar: None. Q. Le: Research Grant; Amgen, NIH, Redhill. Travel Expenses; BMS. Stock; Aldea. president elect; American Radium Society. Head and Neck Committee Chair; RTOG NRG Cooperative group. M. Diehn: Employee; Kaiser Permanente. Consultant; Roche. Stock; CiberMed. B.W. Loo: Research Grant; RaySearch, Varian Medical Systems Inc. Stock; TibaRay, Inc. Vice-chair; National Comprehensive Cancer Network. Chair; American College of Radiology. Board Member; TibaRay, Inc.

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