Author of

• 12544

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  P3.08 - Poster Session 3 - Radiotherapy (ID 199)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Radiation Oncology + Radiotherapy
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12553

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    P3.08-009 - Radiotherapy for postoperative thoracic lymph node recurrence in patients with non-small cell lung cancer without distant metastasis (ID 1216)

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

    Background
    Thoracic lymph node recurrence after complete resection is common in non-small cell lung cancer but it mostly occurs along with distant metastases. The recurrent disease might be localized and curative intent radiation therapy is therefore the treatment of choice if no evidence of hematogenous spreading of the disease is observed. However, the treatment effect and the long-term outcomes of radiotherapy for lymph node recurrences have not been well reported. We sought to describe the treatment effect and the long-term outcomes of radiotherapy for postoperative lymph node recurrences.

    Methods
    Fifty patients that had developed thoracic lymph node recurrence after complete resection received curative intent radiotherapy between 1997 and 2009. The nodal stage at recurrence was N1 in 10 patients, N2 in 28 patients, and N3 in 12 patients. The diagnosis of lymph node recurrence was based on chest CT, FDG-PET, physiological examination, the value of CEA, and/or bronchoscopic sampling for cytology. The cytological evidence was obtained in 10 (20%) patients. Thirteen patients had symptoms associated with recurrent disease. Patients were treated using 3D conformal techniques. Conventional fractionation was used (2-3 Gy/fraction), and the total prescribed dose ranged from 50 to 80 Gy. The clinical endpoints included the tumor response, overall survival, progression-free survival, locoregional recurrence within the irradiated field, and any other recurrence.

    Results
    The planned total radiotherapy was completed in 49 patients. One patient refused further therapy at 56Gy/60Gy due to radiation esophagitis. The median follow-up time after radiotherapy was 41 (19-98) months among the survivors. The response to treatment was complete response in 65%, partial response in 24%, and progressive disease in 10% of the evaluated patients. The 1-year, the 3-year, and the 5-year progression-free survival rates were 49.1%, 28.2%, and 22.2%, respectively. The median progression-free interval was 12.0 months after radiotherapy. In ten patients, no additional recurrence was detected for longer than 3 years after radiotherapy. The median overall survival after radiotherapy was 37.3 months. Fourteen patients survived more than three years after radiotherapy. The 5-year overall survival rate was 36.1% (Figure). A multivariate analysis revealed that the absence of symptoms and the involvement of a single lymph node station were significant factors aFigure 1ssociated with a better overall survival.

    Conclusion
    Radiation therapy for thoracic lymph node recurrence after complete resection is safe and provides acceptable disease control. Early detection of lymph node recurrence may improve better disease control and increase the chance of curing the disease.