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F.S. Van Der Meer

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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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      P1.03-014 - Is Concomitant Chemoradiotherapy Feasible for Patients with NSCLC Stage III A/B? (ID 1369)

      09:30 - 17:00  |  Author(s): F.S. Van Der Meer

      • Abstract
      • Slides

      In patients with NSCLC approximately 25% has locally advanced disease. For the group of patients with mediastinal lymph node metastasis the standard treatment consists of concomitant chemoradiotherapy. Concomitant chemoradiotherapy improves survival compared to sequential chemoradiotherapy in patients with locally advanced NSCLC, but has a higher toxicity.

      This is a retrospective cohort analysis of all patients with NSCLC stage IIIA/B treated in our hospital from 2008-2011. We reviewed primary treatment plans in all patients and evaluated patients primarily treated with sequential and concomitant chemoradiotherapy. Reasons to choose sequential treatment instead of concomitant treatment were reviewed. In both treatment groups completing of treatment and causes to discontinue treatment were explored.

      180 patients with NSCLC stage IIIA/B (103 stage IIIA, 77 stage IIIB) were treated in our hospital between 2008 and 2011. Surgery was the primary treatment in 28 patients (16%), chemotherapy in 22 patients (12%), radiotherapy in 16 patients (8%), best supportive care was agreed on in 32 patients (18%). In 78 (43%) patients the primary treatment was chemoradiotherapy, of who 31 were planned to receive concomitant treatment and 47 were planned to receive sequential treatment. Most frequent reasons to choose sequential instead of concomitant chemoradiotherapy were: radiation field too large (N=24) and physical condition (co-morbidity, age, poor performance score or poor lung function; N=17). Other reasons to start sequential therapy were: planning to evaluate the possibility of resection after chemotherapy (N=1), no pathological diagnosis (N=1), suspicion of second tumor (N=1) or unknown (N=3). In 20 of the 31 patients planned for concomitant chemoradiotherapy, total treatment was completed. Two patients deceased before start of therapy, five patients switched to sequential planning before start of therapy because of patients wish (N=1), radiation field too large at CT planning at radiotherapy (N=3), suspicion of cerebral tumor: (N=1) or decrease of performance score (N=1). In two patients treatment was disturbed by toxicity: one patient developed a pulmonary cavitating infection, radiotherapy was discontinued after 20Gy, the other patient switched to sequential schedule after a pulmonary infection during the first treatment cycle. In 32 of 47 patients planned for sequential therapy treatment was completed. One patient deceased before start of therapy. In one patient the radiation field was still too large after chemotherapy. Three patients developed hemoptysis and were treated primary with radiotherapy. Three patients discontinued treatment because of disease progression. Three patients discontinued during chemotherapy because of kidney failure(N=1) or other toxicity (N=2). Of one patient cause of discontinuation was not documented. One patient showed mediastinal downstaging after chemotherapy and a resection was performed.

      Although concomitant chemoradiotherapy is the standard of care in patients with stage IIIA/B NSCLC, more than 50% of the patients were treated otherwise. Only 17% of the patients were eligible for concomitant chemoradiotherapy. Most frequent reasons to refrain from concomitant chemoradiotherapy were the size of the radiation field and performance status of the patients (87%).

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