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Laura Pemberton
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P2.08 - Oligometastatic NSCLC (ID 172)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Oligometastatic NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.08-02 - Outcomes Following Stereotactic Radiosurgery for Syncronous Brain Metastases in Non-Small Cell Lung Cancer (ID 426)
10:15 - 18:15 | Author(s): Laura Pemberton
- Abstract
Background
Approximately 10% of non-small cell lung cancer (NSCLC) patients have brain metastases at presentation. The use of stereotactic radiosurgery (SRS) has enabled a proportion of patients with oligometastatic brain disease to be offered a radical treatment in conjunction with SRS. We evaluated the outcomes for patients presenting with synchronous brain metastases who received SRS to determine if radical treatment improves survival.
Method
164 patients with NSCLC received SRS for brain metastases between January 2012 and December 2017. This analysis focused on 71 patients who presented synchronously with brain metastases. Electronic patient records were accessed in March 2019 to determine initial extracranial disease treatment and date of death or last follow up.
Result
30 patients received radical treatment (18 radiotherapy alone, 11 chemo-radiotherapy and one surgery) and 24 received palliative treatment (17 chemotherapy, four radiotherapy and three tyrosine kinase inhibitor). 17 patients received no treatment following SRS, either due to death, deterioration in performance status or patient choice. Baseline demographics are presented in table 1.
Median overall survival for the radical, palliative and no treatment groups were; 7.9 (95% CI 5.5-14.0), 9.4 (6.6-14.4) and 1.4 (1.0-2.9) months, respectively. There was no significant difference in survival between the radical and palliative groups (p=0.43). Kaplan-Meier survival estimates at 12 and 24 months were 30.0% (95% CI 17.4- 51.8%) and 10.0% (3.4-29.3%) for the radical and 33.3% (18.9- 58.7%) and 13.0% (4.1-41.4%) in the palliative group, respectively.
Conclusion
Our results did not demonstrate the benefit for radical treatment, as expected based on published data. Potential reasons for this result include a lack of tools to select patients for radical treatment. Prospective studies are needed to identify the optimal treatment for extracranial disease in this patient group.
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P2.17 - Treatment of Early Stage/Localized Disease (ID 189)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.17-02 - Survival in Performance Status 3 Non-Small Cell Lung Cancer Patients Receiving Radical Radiotherapy (ID 291)
10:15 - 18:15 | Author(s): Laura Pemberton
- Abstract
Background
International guidelines currently recommend radical radiotherapy for non-small cell lung cancer (NSCLC) patients with ECOG performance status (PS)0-2. Despite a paucity of evidence for treating poorer PS patients, modern advances have allowed patients with PS3 to be offered radical radiotherapy.
Method
PS0-3 NSCLC patients receiving radical radiotherapy at The Christie Hospital, UK between August 2016-October 2017 were retrospectively identified from hospital electronic patient records. Survival was calculated from date of first oncology review to November 2018. Baseline and treatment characteristics for PS3 patients were recorded including adult comorbidity evaluation (ACE)-27 score, pulmonary function, radiation dose volume parameters and radiotherapy regimen (i.e stereotactic ablative radiotherapy (SABR) vs standard radiotherapy (50-55Gy/20 fractions)).
Result
504 patients were identified: 440(87%) PS0-2 and 64(13%) PS3. Six PS3 patients withdrew themselves; four before treatment and two after one fraction. Of 58/64(91%) PS3 patients completing radiotherapy, 43(74%), 4(7%), 10(17%) and 1(2%) were Stage I, II, III and IV at diagnosis, respectively. ACE-27 score was 0, 1, 2 and 3 in 3(5%), 8(14%), 16(28%) and 31(53%) patients, respectively. 31(53%) received SABR and 27(47%) standard radiotherapy. On intention-to-treat analysis, there was no significant difference in survival over 18 months in PS3 patients compared to PS0-2; p=0.858 (Fig.1). There was no significant difference in survival among PS3 patients completing radiotherapy when stratifying by stage(I vs II vs III) (p=0.343), ACE-27 score(1 vs 2 vs 3)(p=0.266), or radiotherapy regimen(p=0.655). Lung function tests(FEV1, FVC) and radiotherapy dose volume parameters(PTV, V5, V10,V20) failed to predict survival of PS3 patients at 6, 12 and 18 months.
Conclusion
This study demonstrates that PS3 patients receiving radical radiotherapy had a similar 18-month survival compared to PS0-2 patients and baseline and treatment characteristics did not predict overall survival in PS3 patients. This suggests more PS3 patients could be considered for radical radiotherapy and further studies with larger cohorts are recommended.
