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Yoo-Kang Kwak



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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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      P2.17-25 - Post-Treatment Neutrophil to Lymphocyte Ratio in Locally Advanced NSCLC Patients Treated with Concurrent Chemoradiotherapy (ID 12815)

      16:45 - 18:00  |  Author(s): Yoo-Kang Kwak

      • Abstract
      • Slides

      Background

      We aimed to investigate the relationship between NLR and prognosis in patients with locally advanced NSCLC who received concurrent chemoradiotherapy as the first line treatment.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively analyzed 62 patients with locally advanced NSCLC treated with definitive CCRT between 2008 and 2016 at Seoul St. Mary’s hospital. We excluded patients who received induction chemotherapy to eliminate their influence on NLR. CCRT consisted of weekly chemotherapy using paclitaxel/carboplatin, docetaxel/cisplatin, docetaxel/carboplatin, and etoposide/cisplatin. Radiotherapy was performed with intensity-modulated radiotherapy (IMRT) or three-dimensional conformal RT (3D-CRT). The median radiation dose was 66 Gy in 33 fractions (range, 52 – 70 Gy). The pre-CCRT NLR was calculated from the nearest CBC within 1 week before CCRT and post-CCRT NLR was calculated using CBC 4 weeks after CCRT. Change of NLR before/after CCRT was also analyzed. The maximally selected log rank test was used to acquire the most significant NLR level related with overall survival (OS).

      4c3880bb027f159e801041b1021e88e8 Result

      The pre-, post-CCRT NLR, and NLR change (post-CCRT NLR/pre-CCRT NLR) cut-off levels were 1.9, 3.15, and 1.6, respectively. The median follow up duration was 11 months (range, 2–71 months). The 3-year OS, loco-regional progression free survival (LRPFS), and distant metastasis free survival (DMFS) were 45.4%, 9.3%, and 6.2%, respectively. The post-CCRT NLR and NLR change were significantly associated with OS and LRPFS. The high post-CCRT NLR group (> 3.15) showed significantly worse OS and LRPFS compared to the low post-CCRT NLR group (≤ 3.15) (3-year OS: 21.2% vs. 46.9%, p=0.005; median LRPFS: 7.7 months vs. 11.3 months, p=0.04). The high NLR change group (> 1.6) had significantly worse OS and LRPFS than the low NLR change group (≤ 1.6) (3-year OS: 32.7% vs. 36.9%, p=0.026; median LRPFS 7.7 months vs. 10.4 months, p=0.025). The pre-CCRT NLR showed a marginally significant difference in OS (3-year OS: 29.1% vs. 56.9%, p=0.062). There was no correlation between NLR and DMFS.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The pre-, post-CCRT high NLR and increased NLR after CCRT are associated with poor prognosis of survival in patients for locally advanced NSCLC. An elevated NLR after CCRT might be an indicator of an increased risk of loco-regional failure. Further studies are needed to confirm the predictive value of NLR and the treatment strategies using NLR.

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    P3.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 983)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.17-07 - The Beneficial Effect of the High Dose Irradiation During Concurrent Chemoradiotherapy in Locoregional Advanced Non-Small Cell Lung Cancer (ID 13115)

      12:00 - 13:30  |  Author(s): Yoo-Kang Kwak

      • Abstract

      Background

      Purpose: To investigate the effectiveness of high dose irradiation in locoregional advanced non-small cell lung cancer (NSCLC) after concurrent chemoradiotherapy (CCRT).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Methods: We retrospectively analyzed 36 patients with stage III NSCLC treated with CCRT between January 2011 and March 2016. CCRT was consisted of weekly chemotherapy using paclitaxel/cisplatin, docetaxel/cisplatin, etoposide/cisplatin or cisplatin alone and median dose of 66 Gy (range 50.0 ~ 73.5 Gy) involved field irradiation during 7-8 weeks. The primary and secondary endpoints were overall survival (OS) and locoregional progression free survival (LRPFS), respectively. The OS and LRPFS were calculated from the start of CCRT using the Kaplan-Meier method. Univariate analysis was done using log-rank test. Significant variables on univariate analysis were included into multivariate analysis using Cox proportional harzard model. Toxicities were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.

      4c3880bb027f159e801041b1021e88e8 Result

      Results: The median follow up duration was 8 months (range 1 ~ 64 month). Among 36 patients, 22 (61.1%) patients showed partial response, 8 (22.2%) patients had stable disease. The 1- and 2-year OS rates were 54.0% and 46.8%. The median OS was 4.2 months in the low dose group (< 64.8 Gy) and 35.4 months in the high dose group (≥ 64.8 Gy) (p < 0.001). The median LRPFS was 4 months in the low dose group and 16.1 months in the high dose group (p < 0.001). The high dose group was shown a significantly better OS and LRPFS. Radiation dose was significantly associated with OS (HR 0.18, p=0.001) and LRPFS (HR 0.24, p=0.013) on multivariate analysis. Grade ≥3 pneumonitis, esophagitis, and hematologic toxicity were shown in 5.6%, 8.3%, and 22.2% of patients.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Conclusions: High dose irradiation may improve treatment outcomes for patients with locoregional advanced NSCLC after CCRT. However, further investigation should be required to confirm our results.

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