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S. Dudani
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P1.05 - Poster Session with Presenters Present (ID 457)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Early Stage NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.05-069 - Stage II NSCLC Treated with Non-Surgical Approaches: A Multi-Institution Report of Outcomes (ID 4552)
14:30 - 15:45 | Author(s): S. Dudani
- Abstract
Background:
Standard management of stage II non-small cell lung cancer (NSCLC) is surgery, often followed by adjuvant chemotherapy. However, some patients do not undergo surgery for various reasons. The optimal non-surgical management of stage II NSCLC is undefined, with a paucity of data to guide decision making in this setting. We examined outcomes of stage II NSCLC patients who were treated with curative, non-surgical approaches.
Methods:
We performed a multi-institution review of stage II NSCLC patients treated non-surgically with curative intent between January 2002 and December 2012, across three major Canadian academic cancer centres. Data on demographics, comorbidities, staging, treatment, and outcome were collected. The primary endpoint was overall survival (OS). Logistic regression and Cox proportional hazard models were used to assess for factors associated with choice of therapy and OS.
Results:
158 patients were included for analysis. Median age 74 years (range 50-91); 44% female; 94% current/former smokers; 67% performance status (PS) 0-1. Stage II groupings: T2b-T3 N0 in 55%; N1 in 45%. The commonest reasons for no surgery were inadequate pulmonary reserve (27%) and medical comorbidities (24%). All patients received radical radiotherapy (RT) (median 60 Gy [range 48-75]). 73% received RT alone; 24% and 3% of patients received concurrent and sequential chemoradiotherapy (CRT), respectively. Of those who received RT only, 39% received conventional (1.8-2 Gy/day), 51% received hypofractionated (2.5-4 Gy/day) and 10% received stereotactic body RT (≥7.5 Gy/day). In multivariate analyses, CRT was less likely in patients ≥70 years old (OR 0.28, 95% CI 0.11-0.70, p=0.006), as well as in those with higher (>5) Charlson comorbidity scores (OR 0.34, 95% CI 0.13-0.90, p=0.03) or low (<10x10[9]/L) white blood cell (WBC) counts (OR 0.26, 95% CI 0.09-0.73, p=0.01). At time of analysis, 74% have died. Median OS was 22.9 months (95% CI 17.1-26.6 months). Patients receiving CRT had significantly longer median OS than those receiving RT alone (39.1 vs 20.5 months, p=0.0019). RT fractionation schedule (p=0.16) and nodal status (p=0.14) did not influence survival. After adjusting for possible confounders, treatment with CRT was associated with improved survival (HR 0.38, 95% CI 0.21-0.69, p=0.001), while elevated WBC (HR 2.45, 95% CI 1.48-4.04, p=0.0005) and poor PS (ECOG 2-3) (HR 1.87, 95% CI 1.16-3.01, p=0.01) were poor prognostic factors.
Conclusion:
Non-surgical approaches to management of stage II NSCLC are varied. Treatment with CRT was associated with significantly longer survival compared to RT alone, and a randomized trial may be warranted in this population.
