2024 World Conference on Lung Cancer (WCLC) - ePosters-EP.09A.06 Assessment of Treatment Outcomes and Chest Wall Toxicity Following Stereotactic Body Radiotherapy for Lung Nodules Adjacent to the Pleura

EP.09A.06 Assessment of Treatment Outcomes and Chest Wall Toxicity Following Stereotactic Body Radiotherapy for Lung Nodules Adjacent to the Pleura

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The study assesses treatment outcomes and chest wall toxicity (CWT) following stereotactic body radiotherapy (SBRT) for lung nodules adjacent to the pleura, conducted by the Ankara University Departments of Radiation Oncology and Thoracic Surgery. SBRT is known for its acceptable toxicity profile in treating peripheral lung lesions, but its application to nodules near the pleura poses a risk of chest wall toxicities (CWT) like chest wall pain (CWP) and rib fractures (RF). Incidences of CWP and RF in literature are 8.94% and 5.27%, respectively, with chest wall V30 being a predictor of CWT.<br /><br />This research involved a retrospective analysis of 70 patients with 74 lesions undergoing SBRT from July 2020 to April 2023. The planning target volume (PTV) excluded volumes intersecting with ribs to minimize toxicity. The median PTV intersecting with the chest wall was 1.5 cc, while key dose metrics were a median chest wall D0.1cc of 55 Gy and median rib dose of 40 Gy.<br /><br />Results showed a 2-year local control rate of 92% following a median follow-up of 21 months. No grade 2 or higher side effects were seen, but grade 1 chest wall toxicity was noted in 8% of patients. There was one grade 1 rib fracture case 21 months post-SBRT, associated with a maximum rib dose of 39.8 Gy, in a patient with a prior history of breast cancer and chest wall irradiation.<br /><br />Conclusively, by adjusting the dose definition for SBRT in lesions close to the pleura to exclude intersecting rib volumes from the PTV, effective treatment outcomes were maintained with minimal toxicity, thereby preserving local control. This approach underscores the importance of careful planning to mitigate CWT in SBRT applications.

Asset Subtitle

Serap Akyurek

Meta Tag

Speaker Serap Akyurek

Topic Metastatic Non-small Cell Lung Cancer – Local Therapies

Keywords

stereotactic body radiotherapy

lung nodules

pleura

chest wall toxicity

chest wall pain

rib fractures

treatment outcomes

local control rate

dose metrics

retrospective analysis