Author of

• 10692

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  P1.08 - Poster Session 1 - Radiotherapy (ID 195)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Radiation Oncology + Radiotherapy
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

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    P1.08-027 - Is there a benefit of lung stereotactic ablative radiotherapy (SABR) in our patients with multiple co-morbidities?: Age-adjusted Charlson Comorbidity Index (ACCI) as a predictor of survival in medically inoperable early stage Non Small Cell Lung Cancer patients treated with definitive radiotherapy (ID 3392)

    09:30 - 16:30  |  Author(s): J.R. Pantarotto
    • Abstract

    Background
    The Age-adjusted Charlson Comorbidity Index (ACCI) was originally developed as a tool to predict survival for a wide range of patients based on their co-morbidities. As a growing proportion of Stage I non-small cell lung cancer (NSCLC) patients are treated with radiotherapy alone, in part due to extensive comorbidities, we hypothesize that a) ACCI is a useful prognostic tool for this understudied group of patients and b) the advent of stereotactic ablative radiotherapy (SABR) has lead to a redistribution of patients such that more patients of the poorest class are now treated, with similar or better survival.

    Methods
    A single institution, ethics-approved database with outcome data for 406 Stage I NSCLC patients treated with curative radiotherapy alone from 2001 to 2011 was queried. 283 patients were treated with conventional radiotherapy and 123 with SABR. Conventional doses ranged from 50-60Gy over 15-30 fractions, SABR 48-60Gy over 3-8 fractions. For each patient the ACCI score was retrospectively calculated and then arbitrarily stratified into 3 groups based on score ( ≤3, 4-5, ≥6) (higher score indicates higher number of comorbidities). Log rank test and Kaplan-Meier survival analyses was performed and the relationship between ACCI and survival was assessed using proportional hazards analysis.

    Results
    Median follow up was 26.4 months (22.8 months in the SABR group). The median patient age at treatment was 75 (range 41 to 92) for the entire cohort and for the SABR subset 74 (range 54-89). Percentage of patients by ACCI grouping was 22% (≤3), 48% (4-5) and 30% (≥6) for the entire cohort and for the SABR subset was 21% (≤3), 59% (4-5) and 20% (≥6) (p> 0.05). The median overall survival (OS) from time of diagnosis was 39.6 months (95% CI 34.8-44.4) and by ACCI groupings (≤3, 4-5, ≥6) was 51.6, 39.6 and 30 months (log rank test p=0.023) with hazard ratios for survival of 1.00, 1.45 (p = 0.049) and 1.73 (p = 0.0067) respectively. In the subset of patients treated with SABR, median OS was 46.8 months however there is lack of power to demonstrate any OS difference between ACCI groups.

    Conclusion
    The ACCI is predictive of overall survival in medically inoperable Stage I NSCLC patients irradiated with curative intent. The benefit of radiation is evident in even the poorest of patients (CMI ≥6) with a median survival of 30 months exceeding what one would expect without any treatment at all. Further follow up will be required to comment on any increased benefit with SABR.