PT  - JOURNAL ARTICLE
AU  - Aidan Joseph Cole
AU  - Nicholas Hardcastle
AU  - Guy-Anne Turgeon
AU  - Roshini Thomas
AU  - Louis B. Irving
AU  - Barton R. Jennings
AU  - David Ball
AU  - Tomas Kron
AU  - Daniel P. Steinfort
AU  - Shankar Siva
TI  - Systematic endobronchial ultrasound-guided transbronchial needle aspiration improves radiotherapy planning in non-small cell lung cancer
AID  - 10.1183/23120541.00004-2019
DP  - 2019 Jul 01
TA  - ERJ Open Research
PG  - 00004-2019
VI  - 5
IP  - 3
4099  - http://openres.ersjournals.com/content/5/3/00004-2019.short
4100  - http://openres.ersjournals.com/content/5/3/00004-2019.full
SO  - erjor2019 Jul 01; 5
AB  - Objectives Patients suitable for radical chemoradiotherapy for lung cancer routinely have radiotherapy (planning) volumes based on positron emission tomography (PET)-computed tomography (CT) imaging alone. Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) can identify PET-occult malignancy and benign PET-avid regions. We investigated the impact of EBUS-TBNA on curative-intent radiotherapy in non-small cell lung cancer (NSCLC).Methods A prospective multicentre trial was undertaken, investigating the impact of systematic EBUS-TBNA in addition to PET-CT for patients considered for radical chemoradiotherapy with NSCLC. A subset analysis of patients with discordant findings between PET-CT and EBUS-TBNA was performed. Radiotherapy plans investigated tumour coverage and dose to critical organs at risk (OARs) using PET-CT alone in comparison to PET-CT and EBUS-TBNA.Results Of 30 patients enrolled, 10 had discordant findings between PET-CT and EBUS-TBNA. EBUS-TBNA-derived plans allowed for reduction in dose to OARs in patients downstaged by EBUS-TBNA, and reduced the risk of geographic miss in treating PET-occult disease in four patients where EBUS-TBNA identified malignant involvement of PET-negative lymphadenopathy. With the addition of EBUS-TBNA to radiotherapy planning, reductions were noted of 5.7%, 3.7% and 12.5% for the risks of symptomatic pneumonitis, mean heart dose and mean oesophageal dose, respectively.Conclusions This study demonstrates for the first time that systematic EBUS-TBNA prior to radical-intent radiotherapy significantly improves coverage of subclinical disease through detection of PET-occult metastases. Identification of false-positive lymph node involvement in highly selected cases may reduce radiation dose to critical structures, and risk of organ toxicity.Systematic EBUS-TBNA can identify areas of PET-occult malignancy, improving tumour coverage with radiation, and identify benign nodal regions that are PET positive, which may lead to reduced dose to critical structures such as heart, lung and spinal cord http://bit.ly/2QP42et