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James W Welsh

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    MA06 - Challenges in the Treatment of Early Stage NSCLC (ID 124)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
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      MA06.10 - Stereotactic Ablative Radiotherapy in the Management of Synchronous Early Stage Non-Small Cell Lung Cancers (Now Available) (ID 1924)

      13:30 - 15:00  |  Author(s): James W Welsh

      • Abstract
      • Presentation
      • Slides


      The aim of the study is to evaluate the efficacy and patterns of failure of early stage synchronous non-small cell lung cancer (NSCLC) treated with stereotactic ablative radiotherapy (SABR).


      Patients with synchronous NSCLC who received SABR (50 grays in 4 fractions or 70 grays in 10 fractions) to at least one lesion were reviewed. Synchronous lesions were defined as multiple ipsilateral or contralateral intrapulmonary lesions diagnosed within 6 months.


      Out of a total of 912 patients treated with SABR for early stage NSCLC between 2005 and 2015, 82 (9%) had synchronous disease. The median age was 70 years and 34 (41.5 %) patients were males. The median diameter was 2.1 cm (Interquartile range (IQR) 1.6-3 cm) for index lesions and 1.5 cm (IQR 1.1-2.2 cm) for second lesions. At a median follow-up time of 58 months, the 1, 3 and 5-year progression-free survival (PFS) rates were 85.4%, 47.3% and 28.5%, respectively; the corresponding overall survival rates were 95.1%, 66.9% and 52.4% and the 1, 3 and 5-year local recurrence (LR)-free survival rates were 97.3%, 79.6% and 70.8%, respectively. Among the 39 (47.6%) patients with disease progression, intralobal LR was the first site of failure in 15 (18.3%) patients, with a total of 19 local recurrences out of 169 (11.2%) thoracic lesions. Isolated regional recurrence occurred in 3 (3.7%) patients, and distant failure in 221 (25.6%) patients. On multivariate analysis, factors associated with improved PFS were an improved ECOG PS score (HR 10.786; 95% CI 2.845-40.902; p-value <0.001), DLCO (HR 0.947; 95% CI 0.903-0.994; p-value 0.026) and an index lesion pathology of adenocarcinoma (HR 0.167; 95% CI 0.033-0.841; p-value 0.030). Only the ECOG PS score maintained significance (HR 6.165; 95% CI 2.081-18.263; p-value 0.001) on multivariate analysis for OS. No association was found between the use of chemotherapy as part of the initial management strategy and survival outcomes. Similarly, no difference in outcomes was observed whether all lesions were treated with SABR compared to SABR and other modalities.


      SABR achieves promising long-term survival and tumor control rates and may be a potential curative treatment for synchronous early stage NSCLC. Our data indicates that patients presenting with synchronous NSCLC lesions can be approached as having two separate primary lung tumors, and be offered definitive local therapy with aims of cure.

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