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• 11794

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  P2.12 - Poster Session 2 - NSCLC Early Stage (ID 205)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 2
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11807

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    P2.12-013 - Patterns of recurrence following surgical resection of stage I-III non-small cell lung cancer (NSCLC) (ID 1968)

    09:30 - 09:30  |  Author(s): A. Barling
    • Abstract

    Background
    Despite receiving curative treatment, a significant proportion of patients with locoregional non-small cell lung cancer (NSCLC) will develop recurrent disease. The role of routine surveillance imaging following curative treatment remains controversial, as there is no definitive evidence that early detection and treatment of asymptomatic metastases improves survival. The aim of this study was to explore the patterns of recurrence in stage I-III NSCLC patients treated in routine clinical care.

    Methods
    Retrospective analysis of 218 patients across two tertiary centres in Melbourne, Australia, who underwent surgical resection of stage I-III NSCLC over a 5-year period. Patients who died within 30 days of surgery or with no follow-up data were excluded. Clinicopathologic, treatment and outcome data were collected.

    Results
    Between July 2006 and June 2012, 206 patients underwent surgical resection, with a median follow-up of 30 months. Median age was 69 years (range 46–84), with a male:female ratio of 65 vs 35%. There were 113 (55%), 52 (25%) and 39 (19%) stage I, II and III tumours respectively. One patient had a pathologic complete response to neoadjuvant chemoradiotherapy. Adjuvant chemotherapy was delivered to three (3%), 20 (39%) and 28 (72%) patients with stage I, II and III disease respectively. Nine of 39 (23%) stage III patients received adjuvant radiotherapy. 73 of 206 (35%) patients relapsed at a median of 10.5 months from surgery (range 0.7–46.4). A further 15 (7%) patients were diagnosed with new primary lung cancers and four (2%) with second, non-pulmonary malignancies. Relapses were more frequent in patients with higher stage tumours (Table 1). Of the patients receiving adjuvant or neoadjuvant chemotherapy, 55% developed recurrent disease. Among patients who recurred, 46 (63%) were symptomatic, with 32 of these (70%) requiring emergency or early clinical reviews. In contrast, new primary tumours were significantly more likely to be detected on routine surveillance imaging (87% vs 29% of recurrences, p=0.0001). One-year post-relapse survival was 40% for disease recurrences vs 53% for new primary lung cancers.

    Table 1 – Clinicopathologic features and patterns of relapse in 206 patients with resected stage I-III NSCLC[1]

    	Total N	Disease-free n (%)	Relapsed NSCLC n (%)	New primary lung cancer n (%)
    TOTAL	206	104 (51%)	73 (35%)	15 (7%)
    Stage 0 I II III	1 113 52 39	1 (100%) 70 (62%) 21 (40%) 10 (26%)	0 25 (22%) 21 (40%) 25 (64%)	0 10 (9%) 2 (4%) 3 (8%)
    Chemotherapy receipt Yes No	53 145	17 (32%) 84 (58%)	29 (55%) 42 (29%)	3 (6%) 12 (8%)
    Histology Adenocarcinoma Squamous cell Large cell Other	112 57 15 21	53 (47%) 32 (56%) 6 (40%) 13 (62%)	41 (37%) 18 (32%) 8 (53%) 6 (29%)	9 (8%) 5 (9%) 1 (7%) 0
    Method of relapse detection[2] Routine imaging Symptomatic	34 51	N/A N/A	21 (62%) 46 (90%)	13 (38%) 2 (4%)
    [1]Data for second non-pulmonary malignancies not shown [2]Method of relapse detection not documented in six patients

    Conclusion
    The goals of routine surveillance imaging following curative treatment of NSCLC are two-fold; early detection of: 1) asymptomatic disease recurrence and, 2) new primary lung cancers. Our data demonstrate that the majority of disease recurrences are symptomatic at the time of diagnosis, thus negating the value of routine imaging. In contrast, the high proportion of asymptomatic new primary cancers detected on surveillance imaging supports this approach for patients fit for curative-intent treatment.

  • 11808

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    P2.12-014 - Brain metastases following surgical resection of stage I-III non-small cell lung cancer (NSCLC) (ID 1974)

    09:30 - 09:30  |  Author(s): A. Barling
    • Abstract

    Background
    The brain is a common site of relapse following curative treatment of stage I-III non-small cell lung cancer (NSCLC). Retrospective series estimate actuarial risk of brain recurrence at ~10% for stage I-II and ~30% for stage III tumours. Possible risk factors are young age, non-squamous histology and higher tumour/nodal stage, with survival typically dictated by the presence of extracranial disease. The aim of this study was to review patterns and treatment of brain metastases in patients with relapsed stage I-III NSCLC.

    Methods
    Retrospective analysis of 218 patients with surgically resected stage I-III NSCLC at two tertiary centres in Melbourne, Australia over a 5-year period. Patients who died within 30 days of surgery or with no follow-up data were excluded. Treatment and outcome data for patients who subsequently developed brain metastases are reported.

    Results
    206 eligible patients underwent surgical resection between July 2006 and June 2012. None received prophylactic cranial irradiation. At a median follow-up of 30 months, 73 (35%) patients had relapsed. Twenty-two (30%) had intracranial metastases, ten with brain-only metastases at the time of relapse. The other 12 had concurrent extracranial disease. Median time to brain relapse was 7.7 months (range 0.7-38.6). The incidence of brain relapse increased with higher stage: 6%, 13% and 21% of patients with stage I, II and III disease respectively (Table 1). Relapses occurred at a median of 10.9 (stage I), 8.8 (stage II) and 6.4 (stage III) months from surgery. Brain metastases were noted more frequently in patients with adenocarcinoma. Although 18/57 patients with squamous cell histology relapsed, none were noted to have intracranial metastases. In five patients, asymptomatic brain metastases were detected on routine surveillance imaging and treated with palliative whole-brain radiotherapy. Three of the five had coexistent extracranial disease and died within four months of relapse. The other two had brain-only metastases and remain alive at nine and 16 months from relapse. For all patients, one-year survival following diagnosis of brain metastasis was higher in those with brain-only disease (50%) compared to those with concurrent extracranial metastases (9%).

    Table 1 – Clinicopathologic features in total and brain relapse populations

    	Total population N	Brain relapse n (%)
    TOTAL	206	22 (11%)
    Median age (yrs)	69 (46-84)	69 (50-84)
    Sex M F	134 72	15 (11%) 7 (10%)
    Stage 0 I II III	1 113 52 39	0 7 (6%) 7 (13%) 8 (21%)
    Histology Adenocarcinoma Squamous cell Large cell Other	112 57 15 21	16 (14%) 0 3 (20%) 3 (14%)
    Chemotherapy Adjuvant Neoadjuvant None	50 3 145	6 (12%) 1 (33%) 14 (10%)
    Radiotherapy Adjuvant Neoadjuvant None	12 2 185	5 (42%) 0 16 (9%)

    Conclusion
    In this small retrospective series, the majority of patients who developed brain metastases after curative treatment for NSCLC were symptomatic at the time of relapse. Post-relapse survival was worse in patients with coexistent extracranial disease. None of the incidentally detected asymptomatic brain metastases could be treated curatively, suggesting a limited role for including brain imaging in routine surveillance for resected NSCLC.