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Qixun Chen



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    P2.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 966)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.17-03 - A Propensity-Matched Analysis of Neoadjuvant Chemoradiotherapy and Adjuvant Chemoradiotherapy for IIIA(N2) Non-Small Cell Lung Cancer (ID 14395)

      16:45 - 18:00  |  Author(s): Qixun Chen

      • Abstract

      Background

      Multidisciplinary treatment is the preferred treatment for patients with IIIA(N2) non-small cell lung cancer (NSCLC). A subset of patients with potentially resectable of this disease are managed with trimodality therapy (surgery combined with chemoradiotherapy). However, little data exist to guide which one is better between neoadjuvant chemoradiation followed by surgery and surgery followed by adjuvant chemoradiotherapy. Given that prospective comparative data on these two managements are limited, we compared the two treatments with a propensity-matched analysis.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      All patients undergoing treatment with trimodality therapy for clinical IIIA(N2) NSCLC between January 2012 and December 2016 were reviewed. Patients received individual chemotherapy (regimens depending on the different pathological types: squamous cell carcinoma: Docetaxel 30mg/m2 d1,d8, Cisplatines 25mg/m2 d1-3, repeated every 3 weeks for 2 cycles; non-squamous cell carcinoma: Pemetrexed 500mg/m2 d1, Cisplatin 25mg/m2 d1-3, repeated every 3 weeks for 2 cycles) plus radiotherapy (46-50 Gy/23-25 fractions) at preoperation or postoperation. Age, gender, tumor characteristics, pathological types, pulmonary function, disease-free survival (DFS), overall survival (OS) data were collected. A propensity-matched analysis was performed.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 31 patients underwent neoadjuvant chemoradiation followed by surgery, and 82 received surgery followed by adjuvant chemoradiotherapy. Median follow-up was 27 months. For the entire cohort, the median OS and DFS in neoadjuvant chemoradiation followed by surgery group was 24.0 months (95%CI17.1~29.2) and 16.6 months (95%CI10.9~21.5), which is shorter than 30.6 months (95%CI20.9~39.5) and 19.3months (95%CI11.4~25.7) in surgery followed by adjuvant chemoradiotherapy group (P=0.048 and P=0.037). A propensity matched comparison in a blinded manner (1:1 ratio, caliper distance=0.005) based on age, gender, WHO performance status, pulmonary function (forced expiratory volume in 1 second [FEV1] % and FEV1), pathological types, number of mediastinal lymph nodes and T stage resulted in 22 matched pairs. There were no significant differences between neoadjuvant chemoradiation followed by surgery and surgery followed by adjuvant chemoradiotherapy groups in the median OS (25.3 Vs. 25.0 months, P=0.747) and DFS (16.9 Vs. 17.4 months, P=0.941) respectively. Toxicities associated with chemoradiotherapy and death related with treatments were similar in both groups.

      8eea62084ca7e541d918e823422bd82e Conclusion

      This propensity-matched analysis found multidisciplinary treatment remains a suitable option for a subset of patients with IIIA(N2) disease. Upfront surgery without invasive staging, followed by adjuvant chemoradiotherapy, appears reasonable in resectable N2 disease, simplifying patient care and reducing cost. Participation in clinical trials is essential to define the indications and efficacy in a selected population.

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