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  P1.01 - Advanced NSCLC (Not CME Accredited Session) (ID 933)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall

  • 26240

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    P1.01-10 - Stage III Non-Small Cell Lung Cancer Clinical Outcomes with Surgical Resection After Definitive Neoadjuvant Chemoradiotherapy (ID 14264)

    16:45 - 18:00  |  Author(s): Gavin Henry
    • Abstract
    • Slides

    Background
    

    The role of neoadjuvant CRT followed by surgery (trimodality therapy) continues to evolve in patients with stage III non-small cell lung cancer (NSCLC). To date, limited prospective data exist assessing definitive preoperative radiotherapy doses. We report our clinical experience of high-dose (definitive) radiation-based trimodality therapy.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    Between January 2000 and December 2016, 107 consecutive patients with stage III NSCLC treated with curative intent at our institution with definitive doses of neoadjuvant chemoradiotherapy (CRT) were analyzed. The primary endpoint was overall survival (OS) and secondary endpoint was freedom from recurrence (FFR), analyzed using the Kaplan-Meier method with log-rank testing. Cox regression with forward-model selection was used for the multivariate analyses (MVA).

    4c3880bb027f159e801041b1021e88e8 Result
    

    The patients had a median age of 58.5 years (range: 38-82) and were predominantly Caucasian (76%) with baseline performance status of 0 (69%). Stage grouping, according to the 7^thedition of American Joint Committee on Cancer (AJCC) Lung Cancer Staging criteria, was IIIA: 78.5%, T3/4: 43.9%, N2: 74.8%, N3: 8.4%. CRT was delivered concurrently in 98% of the patients. Median radiation dose was 61.2Gy (range 39.6-69.6Gy); 89% receiving ≥60Gy. Radiation technique was (3D) conformal (71.0%) or intensity-modulated radiotherapy (IMRT) (27.1%). The 30-day and 90-day surgical mortality rates were 4.7% and 7.5%, respectively. At a median follow-up of 30 months (range: 3-186 months), estimated OS and FFR (median/5-year) were 61 months/ 49% and 29 months/ 35%, respectively. On univariate analysis (UVA), age ≥60 (HR, 1.776; 95% CI, 1.084–2.909; P=0.023) and having no health insurance (HR, 3.071; 95% CI, 1.060–8.902; P=0.039; as compared to those with private insurance) predicted for an increased risk of death, while receiving consolidation chemotherapy was associated with improved survival (HR, 0.472; 95% CI, 0.258–0.864; P=0.015). On MVA, age ≥60 was the only characteristic with a continued association with OS (HR, 1.779; 95% CI, 1.056–2.998; P=0.039). On UVA, lack of health insurance was the only predictor of disease recurrence (HR, 6.059; 95% CI, 2.244-16.360; P<0.001).

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    In a carefully selected population, full dose neoadjuvant CRT followed by surgery can achieve high OS and FFR even for stage III NSCLC patients, much higher than recent reports of bimodality therapy (RTOG 0617: median OS of 28.7 months and PACIFIC study: median PFS of 16.8 months). Prospective evaluation of high-dose radiation trimodality therapy versus induction chemotherapy alone is warranted.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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