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David Small

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    MA16 - Prioritizing Use of Technology to Improve Survival of Lung Cancer Subgroups and Outcomes with Chemotherapy and Surgery (ID 142)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Now Available
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      MA16.09 - Clinical Practice and Outcomes in Patients with Stage III Unresectable Non-Small-Cell Lung Canceran Academic Centre, Canada (Now Available) (ID 818)

      15:45 - 17:15  |  Author(s): David Small

      • Abstract
      • Presentation
      • Slides


      The prognosis of patients with stage III unresectable non-small cell lung (NSCLC) cancer is poor: five-year OS is only 19-24% for stage IIIA and 7- 9% for stage IIIB. In light of the approval of immunotherapy maintenance treatment, after completion of CRT, we undertook a retrospective study to characterize management and report outcomes of patients with stage III, unresectable NSCLC treated with chemoradiation (CRT) at the Jewish General Hospital, Montreal.


      Patients diagnosed with stage III unresectable NSCLC,and treated with combined CRT, either concurrent (cCRT) or sequential (sCRT) treatment,between January 2007 to December 2018 were included in the study. Overall survival was calculated using the Kaplan-Meier approach and calculated from the start of radiotherapy. Physician defined progression-free survival was calculated from the start of radiotherapy until documented progression based on radiologic assessment. A multivariate analysis using Cox regression was carried out to assess clinical factors impacting survival.


      134/263 patients were deemed unresectable and received combined CRT. 124/134 (92.5%) received CRT as initial treatment and 10(7.5%) received CRT after progression to stage 3 post surgery for an earlier stage NSCLC.114/134 received cCRT and 20/134 received sCRT. Patients on cCRT were significantly younger with a slight prevalence of non-squamous histology and had N1 or single station N2 disease.Median OS (mOS) was 18.7 months (95%CI, 12.4-24.8) for the overall cohort; mOS in cCRT of 23.3 months (95%CI,14.3-32.2) was significantly better compared to 11.33 months with sCRT (95% CI, 10.2-24.8 p=0.01). PFS was slightly better in patients with cCRT (7.97mo, 95%CI 1.75-11.18) compared to sCRT (5.26mo, 95% CI 4.06-6.48 p=0.08).86/134 (64%) progressed and received subsequent therapy: 49 (57%)-chemotherapy alone, 15 (17.4%)–radiation alone, 13 (15.1%)-immunotherapy and 9 (10.5%)-targeted therapy.In multivariate analysis, the tumor size (HR 1.5, 95%CI 1.08-1.97) and nodal status (HR 2.5, 95%CI 3.34-4.74) were the only prognostic factors for OS. Gender, age, ECOG, smoking status, histology, chemotherapy protocol, subsequent therapy, mutation status and cCRT were not statistically significantin multivariate analysis. cCRT was not significant, likely due to patient selection.


      Unresectable stage III NSCLC is a heterogenous group that is challenging to manage. Combined CRT has beenthe standard of care for this group of pts. In our patient cohort, a trend of improved survival was seen in the cCRT group. Tumor size and nodal status were prognostic factors for OS. Future studies evaluating survival with newer IO therapies is of interest.

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