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M.M. Tin
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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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P2.03-030 - Adjuvant Radiation Therapy Improves Survival in Pathological Stage IIIA N2 Non-Small Cell Lung Cancer Patients Staged with PET (ID 2556)
09:30 - 09:30 | Author(s): M.M. Tin
- Abstract
Background:
Recent studies suggest a possible survival benefit associated with adjuvant radiation therapy (ART) following curative surgery for patients with pathological stage IIIA N2 (pN2) Non Small-cell Lung cancer (NSCLC) but there is no randomized data. Lack of survival benefit observed in some of the studies could be due to some of these patients harbouring unexpected distant metastases. 18-FDG Positron Emission Tomography (PET) scanning has been shown to upstage 24% of patients with stage III NSCLC. We hypothesized that survival benefit may become apparent by excluding patients with unexpected distant metastases who would not benefit from ART with the use of PET staging. The objective of this study is to evaluate whether ART improves overall survival in pN2 NSCLC patients staged with PET.
Methods:
Patients with stage IIIA pN2 NSCLC who underwent pre-operative PET staging and curative surgery in a tertiary thoracic oncology facility between January 1995 and June 2014 were identified from a prospectively collected database. 388 patients fit the selection criteria of which 219 patients (57%) received ART (≥ 45Gy). The impact of ART on survival was analysed using the Kaplan-Meier method.
Results:
Median follow up duration was 24 months. 29% of the patients had pneumonectomies. 30 day post-operative mortality was 1.8%. Conformal radiotherapy was used in all patients. 195 patients (51%) received systemic chemotherapy (33% induction, 67% adjuvant). The use of chemotherapy was uncommon in the earlier part of the study. Median age was 65 years (range 29-85 years). The most common histopathology was adenocarcinoma (55%). Patient characteristics, type of resection, complete resection rate, and histopathology subtypes were similar between the group which received ART (219 patients) and the group which did not receive ART (162 patients) but more patients in the ART group received chemotherapy (60% vs.38%). ART group did significantly better in terms of median, 2-year and 5-year Overall Survival (OS) compared to No ART group (median survival 29 months vs. 20 months respectively, 2-year OS 57% vs. 44% respectively, 5-year OS 30% vs.16% respectively, Hazard Ratio 0.62 95% Confidence Interval 0.49 – 0.79; p <0.0001)
Conclusion:
Adjuvant Radiation Therapy improved overall survival in pathological stage IIIA N2 NSCLC patients staged with PET in this series. This is consistent with the growing evidence supporting the use of ART in the modern era. Tri-modality therapy in a large number of patients may have contributed to the superior result in the ART group.
