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Sara Moore
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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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P2.17-23 - Optimal Therapy of Stage III NSCLC: The Role of Surgery in the Era of Immunotherapy (ID 12537)
16:45 - 18:00 | Presenting Author(s): Sara Moore
- Abstract
Background
Curative intent treatment of stage III NSCLC may include surgery, radiotherapy, chemotherapy, or combination therapy. Management is influenced by both patient and disease characteristics. N2 disease is optimally treated with concurrent chemoradiotherapy (CRT) and the role of surgery after CRT remains a subject of debate. The recent PACIFIC study of adjuvant durvalumab after CRT in stage III showed unprecedented improvements in relapse free survival, which further calls into question the role of surgery. We sought to perform a real-world analysis of curative therapies in stage III NSCLC, and explore the impact of known prognostic factors on outcome.
a9ded1e5ce5d75814730bb4caaf49419 Method
A retrospective review was completed of all patients referred to BC Cancer from 2005-2012 with stage III NSCLC treated with curative intent including surgery, radiotherapy, chemoradiotherapy, and combined surgery and radiation +/- chemotherapy (S+RT+/-C). Information was collected on known prognostic factors. The primary outcome measure was overall survival.
4c3880bb027f159e801041b1021e88e8 Result
688 patients were included in the study. Baseline characteristics: female 47%, median age 65, ECOG 0-1 65%, weight loss <5% 74%, stage IIIA/IIIB 73%/27%. Treatment: 82 (12%) surgery, 127 (18%) radiotherapy, 423 (62%) chemoradiotherapy, and 56 (8%) combined S+RT+/-C. Median overall survival: surgery 28.6m, chemoradiotherapy 27.6m, radiotherapy alone 18.0m, and S+RT+/-C 55.9m. In a multivariate model incorporating age, sex, weight loss, ECOG, and stage, the survival difference disappeared between the surgery, chemoradiotherapy, and radiotherapy cohorts and persisted in the S+RT+/-C cohort.
Table 1: Univariate and multivariate analysis of the impact of prognostic factors and treatment cohort on survival Variable UVA MVA HR p-value HR 95% CI p-value Treatment Surgery
Radiotherapy
Chemoradiotherapy
S+RT+/-C
Ref
1.669
0.993
0.475
0.001
0.625
0.001
Ref
1.241
0.912
0.523
0.873-1.764
0.675-1.234
0.330-0.830
0.229
0.552
0.006
Age 1.018 <0.001 1.009 0.999-1.020 0.076 Sex Female
Male
Ref
1.211
0.028
Ref
1.111
0.923-1.338
0.264
Stage IIIA
IIIB
Ref
1.239
0.025
Ref
1.121
0.910-1.381
0.283
ECOG 0-1
>=2
Ref
2.128
<0.001
Ref
1.844
1.468-2.265
<0.001
Weight loss <5%
5-10%
>10%
Ref
1.382
1.557
0.010
0.001
Ref
1.232
1.268
0.959-1.582
0.958-1.678
0.102
0.097
8eea62084ca7e541d918e823422bd82e Conclusion
In stage III NSCLC, the performance of surgery, chemoradiotherapy and radiotherapy alone are comparable after controlling for known prognostic factors. Combined S+RT+/-C appears to provide a significant benefit above other modalities in highly selected patients. The role of surgery post-CRT remains controversial, as immunotherapy demonstrates greater promise for improving outcomes for the diverse group of stage III NSCLC.
6f8b794f3246b0c1e1780bb4d4d5dc53
