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Deog Gon Cho

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    P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)

    • 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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      P3.01-89 - Upfront Surgery Versus Neoadjuvant Treatment Followed by Surgery in Pathologic N2 Non-Small Cell Lung Cancer (ID 12910)

      12:00 - 13:30  |  Author(s): Deog Gon Cho

      • Abstract


      Non-small cell lung cancer (NSCLC) patients with ipsilateral mediastinal nodal metastases (N2) had poor prognosis. Although definitive chemoradiation was frequently used as a standard of care for clinical N2 NSCLC, surgery can be a preferred treatment option in selected patients with upfront surgery plus adjuvant treatment or neoadjuvant treatment followed by surgery. Before starting a prospective study in our institution, we checked a treatment outcome of pathologic N2 NSCLC patients treated by upfront surgery or neoadjuvant treatment approach.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The present study evaluated 21 patients with pathologic N2 NSCLC at St. Vincent hospital from February 2007 to September 2017. Patient with upfront surgery or neoadjuvant treatment followed by surgery was included, and pathologic N2 was confirmed before surgery in neoadjuvant group. Taxane and platinum was used as a neoadjuvant treatment or post-operative therapy in both group. Chemotherapy alone or combined with radiotherapy was conducted. Disease free survival (DFS) and overall survival (OS) was evaluated and Kaplan-Meier survival analysis was used for these analyses.

      4c3880bb027f159e801041b1021e88e8 Result

      Eleven (52%) underwent upfront surgery, and 10 patients (48%) underwent neoadjuvant treatment followed by surgery. Clinical T1N2, T2N2 and T3N2 were 4 (19%), 11 (52%) and 6 (29%), respectively. Baseline characteristics did not show significant difference in these two groups. Upfront surgery group received post-operative treatment including chemotherapy alone (n=7), radiotherapy alone (n=2) or chemoradiotherapy (n=1). Neoadjuvant group received chemoradiotherapy (n=3) or chemotherapy alone (n=10). Regarding DFS, there are no significant differences between upfront surgery group and neoadjuvant group (median DFS, 10.0 months vs. 15.1 months, P=0.925). Five year disease free survival rate was 40% and 30%, respectively. In addition, OS did not show significant differences between two groups (medians OS, 79.5 months vs. 47.7 months, P=0.295). Fiver year overall survival rate were 90% and 50%, respectively. In upfront surgery group, 4 of 7 patients did not complete chemotherapy schedule due to adverse event. But, 9 of 10 patients had a completion of chemotherapy in neoadjuvant group.

      8eea62084ca7e541d918e823422bd82e Conclusion

      There are no significant survival differences between upfront surgery group and neoadjuvant treatment group, but both strategies can be effective treatment option for selected pathologic N2 NSCLC. Further studied need to be done for these patients, and currently our institution are preparing clinical trials in a prospective manner.