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C. Miranda

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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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      P1.03-013 - Clinical Characteristics and Survival in Stage IIIA NSCLC Patients Treated with Neoadjuvant Chemotherapy and Surgery (ID 1020)

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

      • Abstract

      The role of surgery in the management of stage IIIA non-small cell lung cancer (NSCLC) is controversial, with several studies reporting mixed results regarding the benefit of surgery in this group of patients. This study aimed to analyze the clinical characteristics and prognostic factors in stage IIIA patients treated with neoadjuvant chemotherapy followed by surgery.

      We reviewed the medical records of all patients diagnosed with stage IIIA NSCLC at our institution from 2000 to 2012. Tissue diagnosis and PET-Scan at our institution were required. Median follow up was 36 months. Cox regression model was used for multivariate analysis.

      A total of 275 stage IIIA patients were identified, and 84 of those patients were treated with induction chemotherapy followed by surgery. Median age at diagnosis was 65 years (range: 42-82). There were more males than females (68% vs. 32%). 64% of the tumors were located in the upper, 24% lower and 12% middle lobe. Adenocarcinoma was the most prevalent histologic subtype (69%) followed by squamous cell (24%). 57% were poorly differentiated tumors. All patients received cisplatin based chemotherapy; response to induction therapy was: CR 0%, PR 55%, and SD 44%. Median time from induction chemotherapy to surgery was 80 days (range: 15-126). About surgery: 69% were lobectomies, 26% pneumonectomies and 5% wedge resections. Post-operatively, microscopic residual tumor was found in 8% of the patients. Pneumonectomies had a higher post-operatively mortality when compared with lobectomies (5% vs 2%). 50% of the patients received post-surgical radiation. Median overall survival was 19.5 months (95%CI: 14.5-26.7) and when comparing these patients with stage IIIA patients that received chemoradiation alone, a survival benefit was observed (19.5 months vs. 15.8 months). Recurrence was observed in 26% of the patients (64% had local and 36% distal recurrence). Patients that did not receive radiation had a higher risk of recurrence. Male gender (OR: 0.33, p<0.002), age>65 (OR: 2.61, p<0.03) tumor size >4cm (OR: 3.10, p<0.01) and partial response with induction therapy (OR. 0.69, p<0.005) were significant predictors of survival in this group of patients.

      In our cohort, we observed that patients who underwent induction chemotherapy followed by surgery had a higher overall median survival than patients treated with chemoradiation alone. Gender, age, tumor size and response to induction therapy were independent and significant predictors of survival in these patients. Adding radiation therapy to the regimen was associated with a lower recurrence rate. Further research is needed to identify the optimal management of stage IIIA NSCLC as well as the effect of other clinical characteristics on survival.