Outcomes of Stereotactic Ablative Radiotherapy (SABR) for a Second Primary Lung Cancer (SPLC): Evidence in Support of Routine CT Surveillance C. J.A. Haasbeek,

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Outcomes of Stereotactic Ablative Radiotherapy (SABR) for a Second Primary Lung Cancer (SPLC): Evidence in Support of Routine CT Surveillance C. J.A. Haasbeek, G.H.M.J. Griffioen, F.J. Lagerwaard, B.J. Slotman, S. Senan Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands Screening lung cancer survivors for second tumors is only potentially useful when curative treatment options are available. All patients in the VUMC SABR database with a prior history of lung cancer (N=107) were identified. Median follow-up was 46 months and median overall survival 39 months. The 3-year local-, regional- and distant control rates were 89%, 91% and 85%. Twelve patients (11% of total) developed a third (or fourth) primary lung tumor after SABR at a median of 20 months. A comparison between SPLC patients and 756 patients with a ‘first’ early stage lung tumor showed no significant differences in OS (p=0.73), local- (p=0.24), regional- (p=0.49) or distant control (p=0.69). Late radiation-induced pneumonitis necessitating steroid use (grade II) was noted in 7% of patients. In addition, late grade ≥3 toxicity was reported in 4%, including 2 patients with possible grade 5 toxicity (one case of bleeding in an aspergillus-infected lung cavity; another patient experienced hemoptysis and respiratory failure associated with a bronchial stricture). Stereotactic ablative radiotherapy (SABR) achieved high local control with minimal toxicity. Presentation Details: Publishing Title: Outcomes of Stereotactic Ablative Radiotherapy (SABR) for a Second Primary Lung Cancer (SPLC): Evidence in Support of Routine CT Surveillance Session title: Lung 1 - Novel Prognostic Factors and SBRT Date/Time: :15 Location: Room D-1 Monitor number: 6

Characteristicsn (%) or median (range) Male gender73 (68%) Age at SPLC (years)72 (50-90) Treatment-interval (months)48 (6-349) COPD85 (80%) Charlson Comorbidity Index (CCI) 3 (0-10) WHO Performance Score (PS) 1 (0-3) Stage initial lung cancer (7 th TNM) Stage I Stage II Stage III Stage IV Unknown 67 (63%) 18 (17%) 17 (16%) 3 (3%) 2 (2%) Treatment initial lung cancer Lobectomy/bilobectomy/ trimodality Pneumonectomy Wedge/segmentectomy CRT Palliative (CT or RT) 78 (73%) 17 (16%) 3 (3%) 7 (7%) 2 (2%) Stage SPLC (7 th TNM) T1aN0 T1bN0 T2aN0 T2bN0 41 (38%) 34 (32%) 28 (26%) 4 (4%) Diameter SPLC (mm)23 (9-69) PTV SPLC (cc)20.7 ( ) Fractionation scheme SPLC5 (3-8) Dose SPLC (Gy)60 (54-60)

Conclusion SABR achieves good OS and high local control in patients with second primary lung cancer, and toxicity was uncommon, even in patients who may be unfit or unwilling to undergo surgery. These results support the use of CT screening in survivors of lung cancer. Full data: Griffioen, G. (2014). A Brief Report on Outcomes of Stereotactic Ablative Radiotherapy for a Second Primary Lung Cancer: Evidence in Support of Routine CT Surveillance. Journal of Thoracic Oncology, 9(8), 1222–1225