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C.D. Corso

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    P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      P1.03-009 - Integration of Chemoradiotherapy in a Single Facility: Impact on Outcomes for Locally Advanced Non-Small Cell Lung Cancer (ID 1637)

      09:30 - 17:00  |  Author(s): C.D. Corso

      • Abstract
      • Slides

      One of the major challenges to delivering coordinated oncologic care is multimodality management. While it has been hypothesized that providing all treatment in a single institution (“integrated”) may improve access and outcomes, it is unclear whether outcomes are affected by receiving treatment at more than one facility (“nonintegrated”). Our aim was to determine whether integration of concurrent chemoradiation therapy (CCRT) at a single center impacts outcomes for patients with locally advanced non-small cell lung cancer (NSCLC).

      Using the National Cancer Data Base, we identified adult patients with stage III NSCLC diagnosed in 2010-2011. We included non-surgical patients who underwent CCRT with thoracic radiotherapy to 59.4-74.0 Gy delivered at the reporting facility. Demographic, clinicopathologic, and healthcare system characteristics were compared among patients receiving integrated vs. nonintegrated therapy using hierarchical mixed-effects logistic regression analysis with clustering by reporting facility and bootstrapping. Overall survival was compared using Kaplan-Meier analysis, the log-rank test, and Cox proportional hazards regression analysis. Time from diagnosis to radiotherapy initiation was compared using the Wilcoxon rank-sum test given a non-normal distribution.

      A total of 2,794 patients were included, among whom 1,695 (61%) received integrated therapy and 1,099 (39%) received nonintegrated therapy. Patients receiving integrated therapy were significantly more likely to have a Charlson-Deyo comorbidity score ≥1 (OR 1.67, 95% CI 1.24-2.24, p=0.001) and receive treatment at an academic center (OR 3.26, 95% CI 2.13-5.15, p<0.001) compared to those receiving nonintegrated therapy. In both unadjusted and adjusted analyses, there was no difference in overall survival among patients receiving integrated vs. nonintegrated therapy (HR 0.95, 95% CI 0.85-1.06, p=0.33). Time to radiotherapy initiation was also not significantly different among patients receiving integrated vs. nonintegrated therapy (median 35 vs. 36 days, p=0.06). Figure 1

      Our results demonstrate that administering CCRT at more than one facility may not adversely affect survival outcomes for patients with stage III NSCLC, suggesting that this approach may be reasonable based on individual patient preference and specialist availability. Further research is needed to determine the impact of integrated CCRT on tumor control and complication rates.

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