Lung cancer complete radiographic response with PULSAR

Area of Science:

• Oncology
• Radiotherapy
• Pulmonology

Background:

• A high-risk elderly patient with comorbidities including interstitial lung disease (ILD) and pulmonary arterial hypertension presented with a suspicious lung mass.
• Stereotactic ablative body radiotherapy (SABR) was recommended, but the patient's comorbidities and central tumor location posed significant toxicity risks.

Purpose of the Study:

• To evaluate the safety and efficacy of a personalized ultra-fractionated stereotactic adaptive radiotherapy (PULSAR) approach in a high-risk lung cancer patient.
• To assess the feasibility of adaptive radiotherapy in managing treatment-related toxicity and achieving tumor response.

Main Methods:

• The patient received an adaptive personalized ultra-fractionated stereotactic adaptive radiotherapy (PULSAR) regimen, with treatments delivered every 3 weeks.
• A planned 4000 cGy in 5 fractions was adapted based on tumor shrinkage observed during treatment.

Main Results:

• Significant tumor shrinkage was observed after each fraction, leading to a complete radiographic response.
• Treatment was successfully completed after 4 fractions, avoiding the planned fifth fraction due to complete response.

Conclusions:

• PULSAR may provide a safer alternative for high-risk lung cancer patients undergoing SABR, particularly those with ILD.
• Adaptive radiotherapy techniques like PULSAR introduce unique considerations, including the potential for rapid response or progression during treatment.