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A. Salud-Salvia



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    P1.09 - Poster Session 1 - Combined Modality (ID 212)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P1.09-004 - Feasibility and efficacy of inductive chemo or chemoradiation for patients with locally advanced non-small cell lung cancers and reduced respiratory function (ID 297)

      09:30 - 16:30  |  Author(s): A. Salud-Salvia

      • Abstract

      Background
      Half of non-small cell lung cancers are diagnosed a locally advanced stage (LA-NSCLC) and are treated by combining chemotherapy, radiation, and surgery (S). However, many patients are not able to receive complete multidisciplinary therapies due to previous respiratory dysfunctions. We report the feasibility and efficacy of inductive chemotherapy (iCT) or chemoradiation (iCRT) followed by S or consolidative radiation (RT) in LA-NSCLC patients with normal (NRF) and reduced respiratory function (RRF)

      Methods
      We retrospectively reviewed 100 LA-NSCLC ECOG-0-2 patients treated with iCT or iCRT followed by S or RT in our center between October-2004 and June-2012. No patient was excluded to receive treatment due to RRF, but all those without initial determination of basal forced expiratory volume in the first second (FEV1) were not analyzed. Patients were classified into two groups according to initial FEV1: 1) NRF FEV1≥ 60%, and 2) RRF FEV1< 60%. A comparison of toxicity, compliance, treatment modality, and outcome between these groups was performed

      Results
      Seventy-two patients initially presented NRF, and 28 RRF. Seventy (97.2%) patients with NRF completed curative treatments (20 iCRT+S; 20 iCRT+RT; 19 iCT+S; and 11 iCT+RT). Twenty-six patients (92.8%) with RRF completed curative treatments (3 iCRT+S; 14 iCRT+RT; 3 iCT+S; and 6 iCT+RT). The rest of them progressed during inductive treatment and did not receive curative approaches. Any patient interrupted the treatment due to toxicity. Resection rate was lower among patients with RRF (55.7% vs. 23%, p= 0.004), but tolerance to S was similar to those with NRF (p= 0.72). RT was applied in 44.2% and 76.9% of patients with NRF and RRF, respectively. Incidence of grade 3-4 toxicities was similar in both groups of patients (13.9% vs. 11%; p= 0.72). There were no significant differences in disease free survival (16 vs. 21.8 months, p= 0.689), but overall survival paradoxically trended to be better in patients with RRF (27.4 vs. 37.3 months, p= 0.066)

      Conclusion
      RRF does not necessarily contraindicate a multidisciplinary curative approach for LA-NSCLC. In our series, iCT and iCRT were followed by S in 23% of patients with RRF, and by RT in 77%. Outcome of patients with RRF receiving an intentionally curative treatment was at least as good as that of patients with NRF. Figure 1. Kaplan-Meier DFS and OS curves according to initial FEV1. Figure 1

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    P3.09 - Poster Session 3 - Combined Modality (ID 214)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P3.09-002 - I want it all! The better outcome of patients with locally advanced non-small cell lung cancer receiving chemoradiation followed by surgery over any other combination of inductive chemotherapy, radiation or surgery (ID 298)

      09:30 - 16:30  |  Author(s): A. Salud-Salvia

      • Abstract

      Background
      Half of Non-small cell lung cancers are diagnosed in locally advanced stage (LA-NSCLC) and warrant multidisciplinary treatments including chemotherapy, radiation, and surgery (S) in a not well-defined combination and sequence. We compared tolerance and effectiveness of different combos of inductive chemo (iCT) or chemoradiotherapy (iCRT) followed by S or consolidative radiation (RT)

      Methods
      We retrospectively reviewed 108 consecutive LA-NSCLC diagnosed in our center between October-2004 and June-2012 and treated with: 1) iCRT+S (N= 24); 2) iCT+S (N= 31); 3) iCRT+RT (N= 36); 4) iCT+RT (N= 17). Their tolerance, response, and outcome were statistically compared. Survival of five patients that progressed during inductive therapy was not analyzed

      Results
      Mean age of the patients was 66.2 years-old, 92% were male, and 85.1% ECOG-0. Histology was squamous carcinoma in 71.3%, non-specified NSCLC in 15.7%, and adenocarcinoma in 12%. iCT included platin-doublets with taxanes, vinorelbine, and gemcitabine. CBDCA-combinations were commonly used in elderly patients (15.6% vs. 31.8%, p= 0.001). Grade 3-4 toxicity was observed in 14.8% of inductive therapies, without significant differences between iCT and iCRT arms (p= 0.976). No patient interrupted therapies due to toxicity. Progression rate was higher with iCT than iCRT (8.3% vs. 0; p= 0.023). S was performed in 51 patients (pneumonectomy 30%, bi/lobectomy 56%). Severe S complications appeared in 13.7% of cases. Three patients in the iCRT+S arm died due to early postoperative complications. Complete pathologic responses were higher with iCRT than iCT (25% vs. 11.5%, p= 0.049). Resected patients presented better disease free (DFS) and overall survivals (OS) than those definitively radiated (27.9 vs. 12 months, p= 0.000; and 37.8 vs. 25.9 months, p= 0.009). Higher DFS and OS was found among patients of the iCRT+S arm (p= 0.000 and p= 0.049, respectively)

      Conclusion
      Those LA-NSCLC that achieved S after inductive therapy presented a better outcome that those non-resected. iCRT+S was tolerable, feasible, and obtained the higher response and survival rate of our series, although these results are biased by the better prognosis of resectable patients. Anyway, prospective trials are warranted to confirm the benefits of triple multidisciplinary approach. Figure 1. DFS and OS Kaplan-Meier curves of patients according to the treatment arm. Figure 1