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G. Plewicki
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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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P2.03-027 - Predicting the Effect of 7-Days-A-Week Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer Based on Clinicopathological Features (ID 1443)
09:30 - 09:30 | Author(s): G. Plewicki
- Abstract
Background:
Concurrent radiochemotherapy is currently considered as standard treatment for locally advanced non-small cell lung cancer. Some clinical studies suggest, however, that an acceptable treatment outcome can be also obtained with induction chemotherapy followed by accelerated radiotherapy. We explored this direction, considering that not all of the patients are candidates for concurrent treatment. The aim of the present report is to identify clinicopathological features that may help to predict the effect of combined induction chemotherapy and 7-days-a-week radiotherapy.
Methods:
For the purpose of the present report we selected 113 patients from the institutional database that included individuals treated within prospective studies on combined induction chemotherapy and 7-days-a-week radiotherapy . The patients had pathologically confirmed non-small cell lung cancer (74 squamous, 15 adenocarcinoma, 24 NOS), stage IIIA N2 or IIIB. All patients had cisplatin based induction chemotherapy (1-6 courses, median 4) and curative radiotherapy (66-70 Gy, median 69.2 Gy) in 1.8-2.0 Gy per fraction. Fifty seven patients (50.4%) were treated conventionally , 5- days-a- week (CF), while 56 (49.6%) had 7- days-a- week radiotherapy (CAIR). The median dose-intensity of radiotherapy in CF was 9.5 Gy per week compared to 13,4 Gy per week in CAIR. Several clinicopathological features were considered including age, sex, general performance status, gross tumor volume, pathology, Hb concentration, response to chemotherapy and SUV from PET/CT scans. Kaplan-Meier method was used to estimate the overall survival, Cox proportional hazard model was used to assess impact of fractionation in subgroups uniform with respect to the clinicopathological features.
Results:
After median follow-up of 2.8 years the actuarial 3-year survival was 37% in CAIR, compared to 28% in CF, the difference was not statistically significant (HR=0.75, p=0.23). Patients with gross tumor volume smaller than the median of 60 cm[3] tended to benefit from CAIR (3 years survival of 49% vs 21% for CAIR and CF respectively, HR=0.54, p=0.11) unlike the patients with gross tumor volume above the median (3 years survival of 30% vs 28% for CAIR and CF respectively, HR=0.93, p=0.83). Likewise, patients with age of 60 years or less tended to have higher 3 years survival in CAIR vs. CF (42% vs. 8%, HR=0.60, p=0.15) unlike the patients with age over 60 years (3 year survival of 34% in both CAIR and CF, HR=1.01, p=0.97). Some other variables studied (pathology, Hb concentration, SUV) had strong prognostic, but not predictive significance (adenocarcinoma, high Hb concentration and low SUV were prognosticators of favorable overall survival).
Conclusion:
The present data suggest that an improvement in overall survival from 7-days-a-week radiotherapy as compared to conventionally fractionated treatment is relatively small in unselected group of patients with locally advanced non-small cell lung cancer treated in sequential fashion. Patients with small gross tumor volume and those with age of 60 years or less tended, however, to benefit from accelerated radiotherapy, unlike those with large tumor volume or with advanced age. Interestingly, the overall survival was satisfactory both in CAIR and CF, that might be attributed to relatively high total radiation doses given sequentially to chemotherapy.
