ABSTRACT
Introduction: Due to COVID-19, NCCC established a Stage III cCRT review clinic. From April 2020 a prospective audit of patients treated was established. Methods: All lung radiotherapy referrals were scrutinised from January-December 2020. Electronic data was obtained from radiotherapy software. Patients treated with cCRT were analysed for: 1) Toxicity data. 2) Hospital admissions. 3) PDL1 status. 4) Adjuvant durvalumab treatment. Patients who received either unimodality radiotherapy or sequential chemoradiotherapy were reviewed for justification for not treating with cCRT . Results: Of 670 patients treated. 295 received palliative and 375 radical radiotherapy. 141 patients received radical radiotherapy (55Gy in 20#). 55 were Stage III NSCLC, 18 received sequential chemoradiotherapy. 49 patients received cCRT, 41 were stage III NSCLC. 55 stage III patients did not receive cCRT. 8 reason codes were identified: 1) Comorbidity (N=16). 2) Size (N=18). 3) No histopathology (N=3). 4) Consented for cCRT, but disease progression/too big at time of radiotherapy planning (N=6). 5) Relapse (N=3). 6) Reason not annotated (N=5). 7) Patient declined (N=2). 8) Adjuvant RT after surgery (N=2). Of the 41 cCRT NSCLC patients. All patients experienced some toxicity. There were no grade 4 toxicity. 2 patients reported Grade 3 toxicity (nausea and fatigue);dyspnoea, cough, fatigue, oesophagitis and nausea being the most common. 4 out of 41 patients were admitted. Reasons were dehydration, chest infection, oesophagitis, hyponatraemia, neutropenia. 1 patient did not proceed to durvalumab, due to deterioration of performance status. 30 out of 41 patients were PDL1 +, of which 26 were consented for durvalumab. Reasons for no durvalumab were: rheumatoid arthritis, inflammatory bowel disease, interstitial lung disease and deterioration after cCRT. Conclusion: cCRT is an effective delivery as an outpatient. However, ongoing audit is imperative to ensure optimal patient treatment. The data as highlights multidisciplinary input is essential, as most cCRT patients experience toxicity. Disclosure: No significant relationships.
ABSTRACT
Introduction: Patients undergoing concurrent chemo-radiation (CCRT) for stage III NSCLC can be clinically and technically challenging to manage due to extensive treatment volumes including lymph nodes, oesophageal and lung radiotherapy tolerances. Patients experience toxicities including: oesophagitis, dehydration, pneumonitis and weight loss. During treatment lung changes can affect tumour position. As a result of Covid-19, our centre optimised the CCRT pathway in April 2020, to formalise a specific cCRT radiographer review clinic, to deliver an outpatient service. Former practice involved delivering inpatient chemoradiotherapy. Aim: To formalise and optimise the cCRT pathway to ensure a resilient streamlined pathway by: 1) Avoid patient admissions by early intervention and management of toxicities. 2) Problem solving of technical imaging challenges while supporting on-treatment radiographers. 3) Supporting clinical consultant oncologists by coordination post cCRT investigations and eligibility for adjuvant immunotherapy. Methods: Treatment consultation included;analysis of daily imaging, dosimetric data, blood results, electronic recording of assessment and management of patients, reviewing medications, arranging fluids, transfusions;timely intervention for chemotherapy. Patient consent for Durvalumab was instigated on the final week of review and any anatomical lung changes from the daily treatment imaging was initiated. Results: Optimisation by combining clinical and technical skills has demonstrated a positive patient and organisational impact. A formalised clinic has ensured the ability to continue to provide a cCRT service, with increasing patient numbers despite Covid-19 . Conclusion: Optimising the pathway has proven cCRT can be delivered as an outpatient service. However, future optimisation is required from the multidisciplinary team to provide prehabilitation and rehabilitation. As the service increases, capacity and resource impact needs consideration. Thus, continual audit of the service is imperative to ensure provision can be maintained. Disclosure: No significant relationships.