1052 - Comparison of Image Guided Thermal Ablation and Stereotactic Body Radiation Therapy for Primary Non-Small Cell Lung Cancer
Presenter(s)
J. Nikitas1, T. Oughourlian1, C. Kashani1, A. Misra1, S. M. Nesbit1, J. Phan1, E. Wang1, D. L. Gage2, A. Lee1, J. Deng1, M. L. Steinberg1, N. Jahanshahi3, M. Yokomizo3, S. Tappuni3, R. Suh3, M. Quirk3, F. Abtin3, and D. Moghanaki1; 1Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, 2Greater Los Angeles VA Medical Center, Los Angeles, CA, 3Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA
Purpose/Objective(s): Image guided thermal ablation (IGTA) and stereotactic body radiation therapy (SBRT) are increasingly used for primary non-small cell lung cancer (NSCLC). Evidence comparing their relative efficacy and safety is limited.
Materials/Methods: This was an IRB approved, retrospective unmatched cohort study of patients treated at a tertiary academic medical center between January 2011-December 2018 with either IGTA or SBRT for primary NSCLC tumors =3 cm in diameter. Treatment site progression was assessed via clinical and radiographic reports. Acute (=3 months) and late (>3 months from treatment) treatment related adverse events (TRAEs) were identified from clinical notes and graded using the Common Terminology Criteria for Adverse Events, v5. Rates of treatment site progression and TRAEs following IGTA and SBRT were compared using Fisher’s exact test.
Results: 252 primary NSCLC tumors were treated with IGTA (n=88) or SBRT (n=164). Patient and treatment characteristics are summarized in Table 1. Median follow up was 55.6 months for IGTA and 37.4 months for SBRT (p=0.03). Among tumors with =12 months of follow up, treatment site progression rates after IGTA and SBRT were 12.3% (9/73) and 1.5% (2/130), respectively (p<0.001). For IGTA, treatment site progression occurred in 0% (0/12), 22.0% (9/41), and 0% (0/20) of tumors =1, >1-2, and >2-3 cm in size, respectively, and in 4.8% (2/42), 26.3% (5/19), and 16.7% (2/12) of tumors =2, >2-4, and >4 cm from the lung periphery, respectively. For SBRT, treatment site progression occurred in 0% (0/25), 1.5% (1/68), 2.7% (1/37) of tumors =1, >1-2, and >2-3 cm in size, respectively, and in 0.8% (1/123) and 14.3% (1/7) of tumors >2 and =2 cm from the proximal bronchial tree, respectively. Acute grade =3 TRAE rates after IGTA and SBRT were 22.7% (20/88) and 1.2% (2/164) (p<0.001). Late grade =3 TRAE rates after IGTA and SBRT were 3.4% (3/88) and 3/164 (1.8%) (p=0.42). TRAEs after IGTA included pneumothorax (n=18), pleural effusion (n=1), hemothorax (n=1), hemoptysis (n=1), and acute respiratory failure (n=2). TRAEs after SBRT included pleural effusion (n=3), pneumonitis (n=1), and pneumothorax (n=1).
Conclusion: SBRT and IGTA have low rates of treatment site progression. Tumor size and distance from the periphery influenced treatment site progression following IGTA. SBRT had lower rates of acute TRAEs and similar rates of late TRAEs.
Abstract 1052 - Table 1: Patient and Treatment Characteristics| IGTA (n=88) | SBRT (n=164) | p-value | |
| Age (years), Median (Interquartile Range [IQR]) | 73 (66-78) | 78 (71-82) | <0.001 |
| Tumor Size (cm), Median (IQR) | 1.7 (1.1-2.1) | 1.6 (1.2-2.1) | 0.74 |
| Prior Lung Cancer | 49 (55.7%) | 58 (35.4%) | 0.002 |
| History of COPD | 32 (36.4%) | 53 (44.9%) | 0.58 |
| Smoking History | 73 (83.0%) | 137 (83.5%) | >0.99 |
| IGTA Modality Radiofrequency Ablation Microwave Ablation Cryoablation | . 7 (8.0%) 42 (47.7%) 39 (44.3%) | ||
| SBRT Dose 54 Gy in 3 Fx 50 Gy in 4 Fx 50 Gy in 5 Fx | . 139 (84.8%) 21 (12.8%) 4 (2.4%) |