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M. Van Vulpen



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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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      P1.03-023 - Changes in Pulmonary Function after Stereotactic Body Radiotherapy and after Surgery for Stage I and II Non-Small-Cell Lung Cancer (ID 2596)

      09:30 - 17:00  |  Author(s): M. Van Vulpen

      • Abstract
      • Slides

      Background:
      Although surgical resection is the standard treatment for stage I and II non-small-cell lung cancer (NSCLC), approximately 20% of these patients are not eligible for surgery. Stereotactic body radiotherapy (SBRT) is a good alternative treatment for these patients. Lung resection will lead to a decrease in pulmonary function. However, previous studies have shown that pulmonary function after SBRT remains either stable or shows a small decline post-SBRT. In this study changes in pulmonary function tests (PFTs) were evaluated at different follow-up durations, up to more than 2 years after treatment in both groups.

      Methods:
      All patients diagnosed with stage I and II NSCLC and treated with SBRT or surgery between 2008 and 2011 at St. Antonius Hospital Nieuwegein, The Netherlands were included. There was no routine protocol for assessment of post-treatment PFTs. Therefore, follow-up durations were categorized in early (0-9 months), middle (10-21 months) and late (≥ 22 months). We assessed forced expiratory volume in 1 second (FEV1) and diffusion capacity to carbon monoxide corrected for the actual hemoglobin level (DLCOc) absolute and percentage of predicted values. Wilcoxon signed-rank test for paired samples was used to analyze statistical differences between baseline- and follow-up PFTs.

      Results:
      Among 230 patients, 123 patients had both pre- and a minimum of one post-treatment PFT. Of the 123 patients, 30 patients were treated with SBRT and 93 patients with surgery. Mean pre-treatment FEV~1~ and DLCOc values were respectively 1.27 liter (54.90% of predicted) and 4.25 mL/min/mmHg (56.11% of predicted) in the SBRT group and 2.44 liter (88.38% of predicted) and 6.10 mL/min/mmHg (71.96% of predicted) in the surgery group. There were significant changes in FEV~1 ~and DLCOc after surgery for all follow-up durations. After SBRT, absolute FEV~1 ~values remained stable up to 22 months. After 22 months a statistical significant change was observed (from 1.27 liter pre-treatment to 1.11 liter (p=0.008). DLCOc was not significantly impaired after SBRT (from 4.25 mL/min/mmHg pre-treatment to 3.47 mL/min/mmHg (p=0.061)), and showed a small, non-significant, increase for the middle-follow-up term (to 5.22 mL/min/mmHg) compared to pre-treatment values.

      Conclusion:
      Surgery results in a decline of pulmonary function short after resection and on long-term, for stage I and II non-small-cell lungcancer. Pulmonary function after SBRT showed a non-significant decline, except for absolute FEV~1~ values at long-term follow-up. Further analysis of these data must reveal if these changes are clinically significant.

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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
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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): M. Van Vulpen

      • Abstract
      • Slides

      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.

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