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F. Schramel
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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
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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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. Schramel
- Abstract
Background:
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.
Methods:
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.
Results:
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.
Conclusion:
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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P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.03-029 - No Inferior Outcomes after Stereotactic Radiotherapy for Stage I and II NSCLC Compared with Surgery (ID 134)
09:30 - 17:00 | Author(s): F. Schramel
- Abstract
Background:
Surgical resection is the treatment of first choice for patients who are diagnosed with stage I and II non-small cell lung cancer (NSCLC). However, last years, stereotactic body radiotherapy (SBRT) has shown to be a good alternative treatment, especially for the elderly or for patients with a poor pulmonary function. We compared the overall survival (OS), progression free survival (PFS) and locoregional and distant recurrence between patients with stage I and II NSCLC treated with SBRT or surgery.
Methods:
Patients who were diagnosed with stage I and II NSCLC between 2008 and 2011 and treated with SBRT or surgery were included. Crude survival and recurrence rates in both groups were evaluated and compared by Kaplan-Meier survival and Cox proportional hazard analyses. Since the selection of treatment is influenced by patients characteristics, we used the propensity score method to account for this bias. Propensity scores were estimated by a logistic regression model that included treatment as dependent variable and age, gender, performance status, FEV~1~, DLCO, nodule diameter and clinical TNM classification as independent variable. The propensity score was added as covariate to Cox proportional hazard analyses to adjust the outcome for patient characteristics.
Results:
The cohort treated with SBRT and surgery consisted of 53 and 175 patients, respectively. Before adjustment for the propensity score, the OS at 1 and 3 years after SBRT was 87% and 43% and after surgery 89% and 70% (HR = 2.42, 95% CI 1.65 – 3.56; p = 0.0001). The PFS at 1 and 3 years was 72% and 39% after SBRT and 80% and 60% after surgery (HR = 2.07; 95% CI 1.43 – 2.99; p = 0.0001). The locoregional recurrence rates at 1 year after SBRT and surgery were 94% and 95% and at 3 years for both 85% (HR = 1.43 ; 95% CI = 0.60 – 3.43; p = 0.42). The distant recurrence rates at 1 and 3 years after SBRT were 73% and 62% and after surgery 88% and 74% (HR = 1.67; 95% CI = 0.96 – 3.92; p = 0.07). After adjustment for the propensity score, the OS and PFS after SBRT were not significantly different compared with surgery (HR = 1.71, 95% CI 0.87 – 3.35; p = 0.12 respectively HR = 1.56; 95% CI 0.83 – 2.93; p = 0.17). The locoregional and distant recurrence rates between SBRT and surgery were also not significantly different (HR = 2.11; 95% CI = 0.56 – 7.75; p = 0.26 respectively HR = 1.24; 95% CI = 0.48 – 3.20; p = 0.65).
Conclusion:
This study shows that, after adjustment for the propensity score, the OS, PFS and recurrence rates after SBRT are not inferior compared with surgery in patients with stage I and II NSCLC. Although, we used the propensity score to reduce the effects of confounding by indication, randomized clinical trials are desired. Due to the lack of these trials, a thorough discussion of the patient individual merits and drawbacks of surgery and SBRT should be the cornerstone of the treatment.
