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MA02 - Miscellaneous Topics in the Management of Early Stage Lung Cancer (ID 116)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Treatment of Early Stage/Localized Disease
- Presentations: 1
- Now Available
- Moderators:Mireia Serra-Mitjans, Thomas A. D'Amico
- Coordinates: 9/08/2019, 10:30 - 12:00, Interlaken (1988)
MA02.11 - Adjuvant Chemotherapy Following SBRT for Early Stage Non-Small Cell Lung Cancer (NSCLC) in Older Patients (Now Available) (ID 1981)
10:30 - 12:00 | Author(s): Vinicius Ernani
Adjuvant chemotherapy following surgery has been shown to be beneficial in NSCLC >4 cm in size, regardless of age. We have recently shown that adjuvant chemotherapy improves overall survival following stereotactic body radiotherapy (SBRT) in patients with tumors ≥4 cm in size. We aim to evaluate the role of adjuvant chemotherapy following SBRT in older patients (>70 years) with early stage NSCLC.Method
Patients (>70 years) diagnosed with clinical stages I-II NSCLC (AJCC 7th Edition) from 2004 to 2013, who received SBRT, were identified using the National Cancer Database (n=7,934). The Kaplan-Meier method was used to estimate overall survival (OS) distributions and the log-rank test was used to compare distributions by treatment strategy. Clinical stages I and II were subdivided according to the TNM staging and log-rank tests was used to compare survival distributions by treatment strategy within each subgroup.Result
There were 3991 male patients (50.3%), and 6219 (78.4%) had stage I disease. Among stage I patients, 670 (10.8%) received adjuvant chemotherapy (defined as chemotherapy within 90 days of completion of SBRT), compared to 742 stage II patients (43.3%) received adjuvant chemotherapy. Median OS was better with SBRT in patients with stage I disease (25.2 vs. 19.9 months; p<0.001); while patients with stage II NSCLC had better OS with SBRT + chemotherapy (19.9 vs. 14.6 months; p<0.001). On multivariate analysis, after adjusting for age, gender and facility type, patients with stage I NSCLC who received SBRT alone had better overall survival [HR for death: 0.79 (95% CI, 0.73, 0.87)]. SBRT alone was associated with an increased risk of death in patients with stage II disease [HR: 1.37 (95% CI, 1.23, 1.53). When patients with N0 disease were evaluated based on tumor size, those with tumors ≥4 cm had better OS with SBRT + chemotherapy (18.5 vs. 15.5 months; p=0.003). In contrast, patients with tumors <4 cm did better with SBRT alone (median OS of 24.1 vs. 20.3 months; p<0.001)Conclusion
Adjuvant chemotherapy following SBRT is associated with improved OS in patients >70 years of age and tumors ≥4 cm in size or lymph node involvement.
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