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Stephen Abel
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P1.12 - Small Cell Lung Cancer/NET (ID 179)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Small Cell Lung Cancer/NET
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.12-20 - Surgical Resection Versus Stereotactic Body Radiation Therapy for T1-2 N0 Typical Bronchopulmonary Carcinoid Tumors (ID 33)
09:45 - 18:00 | Author(s): Stephen Abel
- Abstract
Background
There is an ongoing debate of surgical resection versus stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer. However, no study to date has compared these modalities for early-stage bronchopulmonary carcinoid tumors.
Method
The National Cancer Database was queried for histologically-confirmed T1-2N0M0 typical carcinoid tumors. Additional exclusion criteria were lack of treatment, conventionally-fractionated radiotherapy, or postoperative radiotherapy. Multivariable logistic regression ascertained factors associated with SBRT delivery. Cox proportional hazards modeling examined factors associated with overall survival (OS). Kaplan-Meier OS analysis was performed following propensity matching.
Result
Of 6,276 patients, 98.7% underwent resection (most commonly bi/lobectomy (67%) or sublobar resection (31%)) and 1.3% underwent SBRT (median dose/fractionation of 50 Gy in 4 fractions). Patients receiving SBRT were older, had greater comorbidities, and lower income (p<0.05 for all). Median follow-up had not been reached. SBRT was associated with poorer OS on Cox multivariate analysis (p<0.001). Following propensity matching, median OS was not reached in either group; respective mean and 5-year OS were 95.6 months and 87%, versus 68.8 months and 79% (p<0.001). Differences between cohorts persisted when removing patients who underwent SBRT specifically owing to surgical contraindications (p<0.001).
Conclusion
Surgical resection should remain the cornerstone of therapy for early-stage bronchopulmonary carcinoid tumors. For inoperable cases, SBRT also produces acceptable survival and should be preferred over conventionally-fractionated radiotherapy. However, because causation cannot be implied in any retrospective comparison of surgery versus SBRT, investigations evaluating cancer-related endpoints are required to corroborate these results.
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P2.15 - Thymoma/Other Thoracic Malignancies (ID 185)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Thymoma/Other Thoracic Malignancies
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.15-13 - The Role of Adjuvant Therapy for Atypical Bronchopulmonary Carcinoids: A Population-Based Analysis (ID 32)
10:15 - 18:15 | Author(s): Stephen Abel
- Abstract
Background
Atypical bronchopulmonary carcinoid tumors are rare but carry high recurrence rates following resection. The role of adjuvant therapy remains unclear owing to a lack of high-volume data. To address this knowledge gap, we examined predictors of adjuvant therapy and effects on outcome.
Method
We queried the National Cancer Database for patients with resected stage I-III atypical carcinoid. Adjuvant therapy was defined as chest radiation, chemotherapy, or a combination thereof. Multivariable logistic regression identified predictors of adjuvant therapy. Multivariable Cox regression evaluated predictors of survival. Propensity matching accounted for indication biases.
Overall, 533 stage I/II and 129 stage III patients were identified. Predictors for adjuvant therapy in stage I/II disease were stage II, positive margins, lymph node ratio (LNR) of 1-25%, and more remote year of treatment. Predictors for adjuvant therapy in stage III were female gender and LNR of 26-50%. Median overall survival in stage I/II and III was 116 months and 61 months, respectively. Predictors for survival in stage I/II were age, margins, comorbidity score, and LNR; factors for stage III disease were LNR and more remote year of treatment. Delivery of adjuvant therapy was not independently associated with survival in either stage I/II or III patients. Furthermore, propensity matched analysis did not reveal a benefit to adjuvant therapy.
Conclusion
This study shows no clear survival benefit with adjuvant radiotherapy and/or chemotherapy, even in stage III disease. Although this implies that adjuvant therapy should not be routinely delivered, individualized judgment is still recommended.