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W. Breen
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P2.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 213)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.03-025 - Predictors of Relapse and Evaluation of Post-Operative Radiotherapy in Patients with Resected Stage III (N2) Non-Small Cell Lung Cancer (ID 1291)
09:30 - 09:30 | Author(s): W. Breen
- Abstract
Background:
For patients with stage III (N2) NSCLC treated with surgical resection, chemotherapy improves survival, whereas the role of PORT is controversial. The purpose of this study was to evaluate risk factors for recurrence and the role of PORT in a modern series of patients with surgically resected stage III (N2) NSCLC.
Methods:
A retrospective review was performed of patients with Stage III (N2) NSCLC who underwent curative intent surgical resection at our institution between February 1999 and January 2012. Patients who received neoadjuvant RT were excluded. Chi-Square or Fisher’s exact tests assessed associations between patient/disease characteristics and receipt of PORT. Local control was defined as lack of disease recurrence within the radiation field for PORT patients, or in the mediastinum or resection area for chemotherapy patients. Overall survival (OS), local control (LC), and metastasis-free survival (MFS) were estimated from the date of surgery using the Kaplan Meier method, with between-group comparisons (PORT vs. no PORT) made with the Log-rank test. Univariate Cox proportional hazards models were used to assess association of patient/disease characteristics and outcomes.
Results:
A total of 76 patients were included. Median age was 62.5 years. Histology was adenocarcinoma in 66%. Clinical N stage was N0 (51%), N1 (4%), or N2 (45%). Baseline positron emission tomography staging was performed in 91%. Pre-operative chemotherapy was administered to 21%. Surgery was pneumonectomy in 16%. Median (range) number of positive pN2 nodes was 1 (0-15). Seven patients with biopsy-proven cN2 had negative pN2 nodes after induction chemotherapy. Extranodal extension occurred in 9%. Surgical margins were positive in 4%. Chemotherapy (preoperative and/or postoperative) was administered to 83%. PORT was administered to 41 patients (54%) with a median (range) dose of 50 (41.4 – 60) Gy. Factors associated with increased likelihood of receiving PORT were increasing age (p=0.006) and no receipt of chemotherapy (p=0.0001). Median follow-up time for living patients was 4.5 (range 0.2 – 15.4) years. For all patients, OS at 5 years was 65%. OS at 5 years for patients receiving PORT vs. no PORT was 71% vs. 58% (p=0.19). For all patients, LC at 5 years was 84%. LC at 5 years for patients receiving PORT vs. no PORT was 89% vs. 77% (p=0.16). Factors associated with decreased LC were male gender (p=0.004), pT3/4 (vs. pT1/2, p=0.008). For all patients, MFS at 5 years was 61%. MFS at 5 years for patients receiving PORT vs. no PORT was 62% vs. 61% (p=0.89).
Conclusion:
In this modern series of patients with surgically resected stage III (N2) NSCLC, patients who received PORT (vs. no PORT) had numerically higher rates of OS and LC, although these differences were not statistically significant, potentially related to limited statistical power.
