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S. El Sharouni
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ORAL 10 - SCLC (ID 98)
- Event: WCLC 2015
- Type: Oral Session
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:C. Faivre-Finn, P. Lara Jr.
- Coordinates: 9/07/2015, 10:45 - 12:15, 605+607
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ORAL10.03 - Which Patients with ES-SCLC Should Receive Thoracic Radiotherapy (TRT) Routinely? (ID 41)
10:45 - 12:15 | Author(s): S. El Sharouni
- Abstract
- Presentation
Background:
Although TRT in patients with ES-SCLC did not lead to a statistically significant difference in overall survival (p=0.066), it did improve 2-year survival rates (p=0.004) in the CREST trial (Slotman et al., Lancet 385:36-42:2015). The failure to meet the primary study endpoint has evoked some controversy in the lung cancer community as to which patients should be offered TRT routinely. To define which patients benefit most from radiotherapy, analysis for overall survival (OS), progression free survival (PFS) and recurrence pattern was performed in patients with and without RITD, which was one of the stratification factors in the randomized study.
Methods:
Patients with confirmed ES-SCLC who responded to 4-6 cycles of platinum-etoposide were randomized to TRT (30 Gy/10fx) or control. All received prophylactic cranial irradiation (PCI). The primary study endpoint was OS. Secondary endpoints were PFS, intrathoracic control. relapse pattern and toxicity.
Results:
Out of 495 patients in the intent-to-treat analysis, 434 had RITD (215 allocated to TRT and 219 to the control arm) and 61 had not (32 allocated to TRT and 29 to the control arm). No significant differences in patient characteristics were observed between the groups. In patients with RITD, OS was significantly longer in the TRT-arm (HR 0.81,95% CI 0.66-1.00;p=0.044). Survival rates in the TRT and control arm were 33% (95%CI 27-40) vs 26% (95%CI 21-33) at 1 year, and 12% (95%CI 8-19) vs. 3% (95%CI 1-8) at 2 years, respectively. PFS was also significantly longer in the TRT-arm (HR=0.70, 95%CI 0.57-0.85; p<0.001). Intrathoracic progression was reported in 43.7% of the TRT arm vs. 81.3% in the control arm (p<0.001). There was no significant difference in the risk of brain metastases (10.2% vs. 5.5%). Exclusive progression outside thorax and brain occurred in 37.2% in the TRT arm, compared to 5.9% in the control arm (P<0.001). In patients without RITD, there was no significant difference in OS (HR 1.02, 95%CI 0.59-1.77, p=0.937) and PFS (HR=1,00, 95%CI 0.59-1.70, NS) between the TRT and control arms.
Conclusion:
This additional analysis of the CREST data shows that ES-SCLC patients with RITD after chemotherapy have a statistically significant improvement in OS, PFS and risk of intrathoracic progression if they undergo TRT. No such benefit for TRT is seen in patients without RITD. These findings support the routine use of TRT in patients who respond to chemotherapy but still have residual intrathoracic disease.
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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): S. El Sharouni
- 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%).
