Evaluation of a care path for patients with lung tumors and co-existing interstitial lung disease
Authors: M.I. Ronden-Kianoush, E.J. Nossent, C. Dickhoff, S.F.M. Nijman, I. Bahce, S. Senan, F.O.B. Spoelstra
Journal: Annals of Oncology (2019)

Background: Patients with lung cancer and co-existing interstitial lung disease (ILD) are at increased risk of treatment-related toxicity after both surgery and radiotherapy. A care path was implemented at our institution for patients presenting to the lung tumor board with a possible ILD, and we report on our experience using this structured approach. Methods: Since 2015, patients with possible lung cancer and ILD were referred to the general ILD clinic for assessment. In 2017, a dedicated ILD lung tumor board was established in order to facilitate quick assessment of treatment-related risks. An ethics-approved institutional database containing details of all these patients was accessed. Results: 24 patients with lung tumors and a co-existing ILD were identified (Table). The mean interval between referral to, and consultation at our ILD-board was 2 weeks. A prior diagnosis of ILD was available in 9 of 17 (53%) patients, but review led to a re-classification of the ILD subtype in 8 of the former. Treatments for lung cancer included radiotherapy alone (n = 14), surgery (n = 6), sequential chemoradiation (n = 3), and concurrent CRT followed by salvage surgery (n = 1). 6 patients developed progression of ILD after radiation; of these, 2 had received nintedanib during treatment. One patient died because of progressive ILD and in another 3 patients ILD-related deaths could not be excluded.Table58P Patient characteristics and outcomesGender (n = 24) Male Female. n = 18 (75%) n = 6 (25%)Age (years) (n = 24) Mean Range. 69 48-88Long function tests FVC (liter) (n = 20) Mean Range FVC (% of predicted) (n = 20) Mean Range FEV1 (liter) (n = 23) Mean Range FEV1 (% of predicted) (n = 24) Mean Range FEV1/FVC ratio (n = 21) Mean Range DLCO (% of predicted) (n = 22) Mean Range. . 3.33 2.08-5.47 . 90.95 54-124 . 2.17 1.46-3.66 . 84.96 54-125 . 0.71 0.53-0.87 . 49.15 21-73ILD exacerbation after (lung) cancer treatment (n = 24) Yes No. . n = 6 (25%) n = 18 (75%)Alive or dead (n = 24) Alive Dead. n = 14 (58%) n = 10 (42%)Cause of death (n = 10) Progression of cancer Exacerbation of ILD Septic shock Complication of surgery Ruptured aortic aneurysm Myocardial infarction Unknown. n = 2 n = 1 n = 1 n = 1 n = 1 n = 1 n = 3Time between end date therapy and date of death (days) (n = 10) Progression of cancer 1 Progression of cancer 2 Exacerbation of ILD Septic shock Complication of surgery Ruptured aortic aneurysm Myocardial infarction Unknown 1 Unknown 2 Unknown 3. . 116 656 45 131 17 73 162 282 342 69List of abbreviationsFVC - forced vital capacity. FEV1 - forced expiratory volume in 1 second. DLCO - diffusing capacity of the lung for carbon monoxide Open table in a new tab Conclusions: A dedicated care path for ILD patients resulted in a fast evaluation of lung cancer patients. A previous ILD-diagnosis was revised in a majority of patients, a process which can allow for a better understanding of treatment-related risks in different subgroups of ILD patients, and also assess the role of ILD-directed therapies. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: S. Senan: Grants, during the conduct of the study: ViewRay Inc.; Personal fees, outside the submitted work: Varian Medical Systems. All other authors have declared no conflicts of interest.