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Systematic endobronchial ultrasound-guided transbronchial needle aspiration improves radiotherapy planning in non-small cell lung cancer

Aidan Joseph Cole, Nicholas Hardcastle, Guy-Anne Turgeon, Roshini Thomas, Louis B. Irving, Barton R. Jennings, David Ball, Tomas Kron, Daniel P. Steinfort, Shankar Siva
ERJ Open Research 2019 5: 00004-2019; DOI: 10.1183/23120541.00004-2019
Aidan Joseph Cole
1Dept of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
2Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
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  • ORCID record for Aidan Joseph Cole
  • For correspondence: a.cole@qub.ac.uk
Nicholas Hardcastle
3Dept of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
4Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
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Guy-Anne Turgeon
1Dept of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Roshini Thomas
1Dept of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Louis B. Irving
5Dept of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
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Barton R. Jennings
6Dept of Respiratory and Sleep Medicine, Monash Medical Centre, Clayton, Australia
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David Ball
1Dept of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
7Sir Peter MacCallum Dept of Oncology, University of Melbourne, Melbourne, Australia
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Tomas Kron
3Dept of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
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Daniel P. Steinfort
5Dept of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
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Shankar Siva
1Dept of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
7Sir Peter MacCallum Dept of Oncology, University of Melbourne, Melbourne, Australia
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  • ORCID record for Shankar Siva
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  • FIGURE 1
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    FIGURE 1

    Illustration of value of detection of positron emission tomography (PET)-occult lymph node metastases in patient 1, where nodal station 4R was PET negative but transbronchial needle aspiration (TBNA) demonstrated malignant involvement. a) Endobronchial ultrasound (EBUS)-guided TBNA and PET-planned radiotherapy. b) PET-only planned radiotherapy. The area in red is the planning target volume.

  • FIGURE 2
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    FIGURE 2

    Sagittal view illustrating dose distribution with endobronchial ultrasound (EBUS)-proven malignancy (blue) receiving negligible doses of radiation; positron emission tomography (PET)-positive disease (yellow) received a high dose (>57 Gy).

Tables

  • Figures
  • TABLE 1

    Patient demographics and staging information

    PatientSitePathologyEBUS-sampled stationsStations sampled nEBUS positiveEBUS negativeDiscrepant sites#
    Upstaged1RLLAdenocarcinoma7, 4R27, 4RNone4R
    2RULNSCLCPre-carinal, 7, 2R3Pre-carinal7, 2R4R
    3Left hilumSquamous7, LLL, 4L37, LLL4L7
    4RULAdenocarcinoma4R, 7, 11R37, 11R4R7
    Downstaged5RLLSquamous4R, 7274R2R, 4R
    6RLLSquamous4L, 2R, 4R, 2L, 7, 11R67, 11R4L, 2R, 4R, 2L2L, 4L, 2R, 4R
    7RLLNSCLC4R, 4L, 11R, 7411R, 7 (atypia)4R, 4L4R, 4L
    8RLLNSCLC4R, 4L24R, 4LNone2R
    9RULSquamous4R, 7, 10R37, 10R4R2R, 4R
    10RULNSCLC2R, pre-carinal, 4R, right hilum4Pre-carinal2R, 4R, right hilum2R

    EBUS: endobronchial ultrasound; RLL: right lower lobe; RUL: right upper lobe; NSCLC: non-small cell lung cancer. #: between positron emission tomography-computed tomography and EBUS-guided transbronchial needle aspiration.

    • TABLE 2

      Target and organ at risk doses

      EBUS-upstaged#EBUS-downstaged¶
      EBUS-TBNA+PETPETEBUS-TBNA+PETPET
      PTV D95% Gy58.1±2.716.3±3.359.7±0.658.6±1.1
      Mean heart Gy10.9±7.98.4±7.412.2±3.515.9±8.4
      Mean oesophagus Gy18.5±5.612.0±5.716.6±10.429.1±5.2
      Lung NTCP %9.6±2.07.6±1.512.6±5.318.3±5.3

      Data are presented as mean±sd. EBUS: endobronchial ultrasound; TBNA: transbronchial needle aspiration; PET: positron emission tomography; PTV: planning target volume; D95%: treatment volume receiving >95% of planned dose; NTCP: normal tissue complication probability. #: EBUS-positive/PET-negative, n=4, dose was changed; ¶: EBUS-negative/PET-positive, n=4 (because two out of six patients where EBUS identified a lesser extent of lymph node disease could not reasonably be encompassed within a radical radiotherapy field when planned based on PET alone and therefore plans were not created), potential change in dose.

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      Systematic endobronchial ultrasound-guided transbronchial needle aspiration improves radiotherapy planning in non-small cell lung cancer
      Aidan Joseph Cole, Nicholas Hardcastle, Guy-Anne Turgeon, Roshini Thomas, Louis B. Irving, Barton R. Jennings, David Ball, Tomas Kron, Daniel P. Steinfort, Shankar Siva
      ERJ Open Research Jul 2019, 5 (3) 00004-2019; DOI: 10.1183/23120541.00004-2019

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      Systematic endobronchial ultrasound-guided transbronchial needle aspiration improves radiotherapy planning in non-small cell lung cancer
      Aidan Joseph Cole, Nicholas Hardcastle, Guy-Anne Turgeon, Roshini Thomas, Louis B. Irving, Barton R. Jennings, David Ball, Tomas Kron, Daniel P. Steinfort, Shankar Siva
      ERJ Open Research Jul 2019, 5 (3) 00004-2019; DOI: 10.1183/23120541.00004-2019
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