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Hao Long
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OA06 - Early Stage Lung Cancer: Outcomes and Interventions (ID 902)
- Event: WCLC 2018
- Type: Oral Abstract Session
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 13:30 - 15:00, Room 202 BD
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OA06.02 - Video-Assisted Thoracoscopic Surgery vs. Thoracotomy for Non-Small Cell Lung Cancer: Oncologic Outcome of a Randomized Trial (ID 12455)
13:40 - 13:50 | Author(s): Hao Long
- Abstract
- Presentation
Background
Video-assisted thoracoscopic surgery (VATS) has been widely used in the treatment of early-stage non–small cell lung cancer (NSCLC). However, there has not been a robust randomized control trial (RCT) to conclude VATS has similar oncologic efficacy to open surgery. Therefore, a large multicenter RCT in China was designed and initialed in order to verify the role of VATS.
a9ded1e5ce5d75814730bb4caaf49419 Method
A non-inferiority phase 3 RCT was undertaken at five thoracic surgical centers in China. Patients aged 18-75 years who were diagnosed of clinically early-stage NSCLCs were randomized in a 1:1 ratio into VATS and thoracotomy groups. Radical lobectomy plus hilar and mediastinal lymph node dissection was the standard surgical intervention as per protocol. The long-term oncologic outcomes including 3-year locoregional recurrence rate, overall survival (OS) and disease-free survival (DFS) would be analyzed and reported here. This study is registered with the ClinicalTrials.gov, number NCT01102517.
4c3880bb027f159e801041b1021e88e8 Result
A total of 508 patients were recruited in the trial between January 2008 and March 2014. And 433 patients were eligible for final analysis (222 cases in VATS group and 211 cases in thoracotomy group). At 3 years, the locoregional recurrence rates were 4.5% in VATS group and 5.7% in thoracotomy group respectively (P=0.664). Patients who received VATS procedures had a similar DFS rate to those who underwent open surgery (66% versus 69%, P=0.925; Fig 1A). Again, the 3-year OS rates were of no significant difference between VATS and thoracotomy groups (74% versus 73%, P=0.382; Fig 1B).
8eea62084ca7e541d918e823422bd82e Conclusion
VATS in the treatment of clinically early-stage NSCLCs was associated with equivalent oncologic efficacy when compared to open surgery.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P1.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 947)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.15-17 - Risk Factors of Local Recurrence in EGFR-Mutant Stage III-pN2 Adenocarcinoma After Complete Resection: A Multi-Center Real-World Cohort Study (ID 12740)
16:45 - 18:00 | Author(s): Hao Long
- Abstract
Background
Postoperative radiotherapy (PORT) of complete resected stage IIIA non-small cell lung cancer with N2 nodal involvement remained contentious. Our previous study suggested low locoregional recurrences in epidermal growth factor receptor (EGFR) mutant patients. We sought to launch a multi-center large cohort study to evaluate the risk factors of locoregional recurrence in R0 resected EGFR mutant III-pN2 patients without PORT, producing evidence for the design of adjuvant regimens.
a9ded1e5ce5d75814730bb4caaf49419 Method
Three-hundred and fifty-nine consecutive patients with complete resected, pathological approved stage III-pN2 lung adenocarcinoma with sensitive EGFR mutation (exon 19 or exon 21) have been investigated. Patients were excluded if they received induction therapy (7.5%) or PORT (9.6%). Three hundred cases have been analyzed. Clinicopathologic characteristics, pretreatment work-ups, EGFR mutant status and patterns of failure were documented. Patients were sub-staged by the International Association for the Study of Lung Cancer (IASLC)/ the Union for International Cancer Control (UICC) 7th classification on N2 disease. Risk factors of locoregional recurrence-free survival (LRFS) were evaluated by univariate and multivariate analyses.
4c3880bb027f159e801041b1021e88e8 Result
According to IASLC/UICC 7th classification, there were 198 (66.0%) patients with unforeseen N2 (N2a), 36 (12.0%) with minimal/single station N2 (N2b), 41 (13.7%) with selectively centrally located N2 (N2c) and 25 (8.3%) with bulky and/or multilevel N2 (N2d). After surgery, 70 (23.3%) patients were treated with adjuvant tyrosine-kinase inhibitors (TKIs), while other 230 (76.7%) were free from adjuvant TKIs. With median follow-up of 28.5 (range：6-133) months, the 2-year LRFS, distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were 88.3%, 65.3%, 57.7% and 89.7%. Ultimately, 15.7% (47/300) patients developed locoregional recurrences. Distant metastasis was the predominant failure pattern. Multivariate analysis indicated that N2d disease (HR: 2.65, p=0.030) and extranodal extension (HR: 3.48, p<0.001) were risk factors of LRFS.
8eea62084ca7e541d918e823422bd82e Conclusion
R0 resected stage III-pN2 NSCLC patients with sensitive EGFR mutation (exon 19 or exon 21) tended to present limited N2 disease and low locoregional recurrences. Patients without bulky N2, multilevel N2, and extranodal extension might be refrained from PORT. Further studies evaluating the optimal radiotherapy approach for completely resected N2-positive NSCLC are required for validation.
6f8b794f3246b0c1e1780bb4d4d5dc53
