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Annemarie Shepherd



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    P1.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 949)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.17-13 - The Role of Post-Operative Radiation Therapy in Patients with Locally Advanced NSCLC after Nodal Down-Staging with Systemic Chemotherapy (ID 14251)

      16:45 - 18:00  |  Presenting Author(s): Annemarie Shepherd

      • Abstract
      • Slides

      Background

      Post-operative Radiation Therapy (PORT) has been shown to improve local-regional control and overall survival in patients with non-small cell lung cancer (NSCLC) undergoing surgical resection with pathologic N2 nodal involvement. It is unclear if PORT is needed in patients with clinical N2 involvement who are downstaged with neoadjuvant chemotherapy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The National Cancer Database was queried for patients diagnosed between 2006-2015 with clinical N2, Stage IIIA NSCLC and treated with neoadjuvant chemotherapy followed by R0 surgical resection with either a lobectomy or pneumonectomy. Patients were included if they were alive for at least 3 months following their diagnosis.

      Kaplan Meier method was used for overall survival (OS) analysis.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 1,174 patients were evaluated. The median age was 65 years (range: 33-89). Most patients were treated with lobectomy (90%). The median radiation (RT) dose was 50.4 Gy (range: 45-54 Gy). Pathologic downstaging and OS rates with and without PORT are demonstrated in Table and Figure.

      Survival Rates
      ypN STAGE PORT (N=303) No PORT (N=871) p-value

      ypN0 (N=477)

      Median OS

      1 yr OS

      2 yr OS

      5 yr OS

      N=63

      73.1 months

      100%

      89.9%

      62.6%

      N=414

      67.5 months

      93.6%

      78.2%

      52.6%
      0.089

      ypN1 (N=182)

      Median OS

      1 yr OS

      2 yr OS

      5 yr OS

      N=39

      71.0 months

      89.7%

      68.6%

      58.7%

      N=143

      43.8 months

      82.4%

      67.0%

      38.3%
      0.172

      ypN2 (N=512)

      Median OS

      1 yr OS

      2 yr OS

      5 yr OS

      N=198

      46.1 months

      89.9%

      71.5%

      39.5%

      N=314

      39.8 months

      84.8%

      63.2%

      35.9%
      0.072

      All patients (N=1,174)

      Median OS

      1 yr OS

      2 yr OS

      5 yr OS

      N=303

      55.0 months

      91.7%

      74.8%

      46.9%

      N=871

      50 months

      88.6%

      71.3%

      44.3%
      0.211

      ncdb nodal downstaging survival curves for wclc 2018.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our data demonstrate a trend for improved OS with PORT. Although this is a population-based study, this lack of statistical significance may be attributable to a small sample size as the OS curves indicate a consistent benefit with PORT.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P1.17-14 - Outcomes of Hypofractionated Radiation Therapy (HFRT) with Concurrent Chemotherapy in Patients with Stage III Non Small Cell Lung Cancer (NSCLC) (ID 14250)

      16:45 - 18:00  |  Presenting Author(s): Annemarie Shepherd

      • Abstract
      • Slides

      Background

      Patients with unresectable locally advanced NSCLC are often treated with concurrent chemoradiation. HFRT regimens are becoming increasingly common due to convenience and healthcare costs. A database analysis was performed to evaluate the outcomes of HFRT with concurrent chemotherapy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The National Cancer Database (NCDB) was queried for patients with stage III NSCLC who received RT (50 Gy-80 Gy) with concurrent chemotherapy without surgery from 2004-2015. Patients were defined as receiving concurrent chemotherapy if chemotherapy was started within 3 weeks of the start of radiation. Patients received conventionally fractionated RT (CFRT): 180-200 cGy/fraction (fx) or HFRT: 210-400 cGy/fx. Baseline characteristics were compared. Kaplan Meier method was used for overall survival (OS) and Cox-proportional hazards were used for uni- and multivariable analyses (UVA/MVA).

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 54,559 patients were evaluated: 50,938 CFRT and 3,621 HFRT. Patients treated with HFRT were more likely to receive RT at an academic center (32.6% vs. 27.2%, p<0.01), more likely to have higher T-stage (cT3/T4: 56.5 vs. 49.2%, p<0.01) but lower N-stage (cN2/3: 77.6% vs. 81.4%, p<0.01). There was no difference in age (median 66 yo), sex, race, insurance, education, Charlson-Deyo Comorbidity Score (CDCS), tumor location, or grade. For the CFRT and HFRT groups, the median RT dose, Biologic Equivalent Dose (BED) and dose/fx were 64 Gy; 76.4; 185 cGy/fx and 65 Gy; 80.5; 235 cGy/fx, respectively.

      The median and 2-yr rates of OS were 19.8 mos and 43.2% for CFRT vs 16 mos and 36.1% for HFRT (p<0.01).

      On UVA and MVA, (data shown for MVA: HR, p-value), age (1.01, <0.01), male gender (1.2, <0.01), white race (1.09, <0.01), Medicare (1.04, <0.01), urban dwelling (0.93, <0.01), distance from treatment center (0.999, <0.01), treatment at an academic center (0.91, <0.01), CDCS (1: 1.11, <0.01, 2: 1.21, <0.01, 3: 1.29, <0.01), diagnosed 2010-2014 (0.85, <0.01), upper lobe location (0.89, <0.01), T3/T4 stage (1.15, <0.01), N2/N3 stage (1.12, <0.01), stage IIIB (1.11, <0.01), HFRT (1.26, <0.01) and BED (0.99, 0.01) were associated with OS.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Patients who received HFRT had slightly inferior OS rates, which may be due to toxicity (not captured in the NCDB) or unaccounted confounders such as baseline performance status and aggressiveness of disease.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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