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N. Levin
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P3.07 - Poster Session/ Small Cell Lung Cancer (ID 223)
- Event: WCLC 2015
- Type: Poster
- Track: Small Cell Lung Cancer
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.07-016 - Survival of Patients with N3 Lymph Node Disease in a Cohort with Limited Disease Small-Cell Lung Cancer Receiving Concurrent Chemoradiotherapy (ID 1134)
09:30 - 09:30 | Author(s): N. Levin
- Abstract
Background:
Treatment of small-cell lung cancer depends on the extent of disease. Concurrent chemotherapy and thoracic radiotherapy (TRT) is recommended if all lesions can be included in a radiotherapy field (limited disease – “LD”), while patients with more advanced disease (extensive disease – “ED”) receive chemotherapy alone. LD is defined as confined to one hemithorax, but some have excluded patients with contralateral hilar and supraclavicular lymph node metastases (LNM). When the latest revision of TNM was published, it was recommended that N3-disease should be considered as LD with the possible exception of supraclavicular LNM – and that TNM-stage should be reported in clinical trials of LD SCLC to further explore this. We assessed extent of disease according to TNM v7 in patients from a randomized phase II trial comparing two schedules of TRT in LD SCLC (n=157) and investigated whether N3-disease was a negative prognostic factor; and whether there were survival-differences between the different N3-subcategories.
Methods:
Patients received four courses of cisplatin plus etoposide and were randomized to receive concurrent thoracic radiotherapy of either 45 Gy/30 fractions (twice-daily) or 42 Gy/15 fractions (once daily). Responders were offered prophylactic cranial irradiation of 30 Gy/15 fractions. Extent of disease was assessed from CT scans obtained three weeks before chemotherapy commenced. N3-disease was categorized according to contralateral supraclavicular, ipsilateral supraclavicular, contralateral hilar and contralateral mediastinal LNM. Weight loss was defined as weight loss >5% the last 3 months prior to enrolment.
Results:
150/157 patients were analysed (96%). Median age was 63 (40-85); 51% were men; 15% had PS 2 and 46% received twice-daily TRT. 1% had stage I disease; 14% stage II; and 84% stage III. Median overall survival (OS) for stage I: not reached, stage II: 41.1 months, and stage III: 20.9 months (p=0.022). 17% had N0-disease; 5% N1-disease; 30% N2-disease; and 47% had N3-disease. Among those with N3-involvement, 40 % had contralateral mediastinal LNM, 16% contralateral hilar LNM, and 17% supraclavicular LNM (13% ipsilateral and 7% contralateral supraclavicular LNM). 43% had LNM to more than one N3-station. Patients with N3-disease had inferior survival compared with N0-2 disease (18.0 vs. 33.7 months; p<0.001). All subcategories of N3 had inferior median OS compared with N0-2 disease (median 33.7 months): contralateral mediastinal LNM (18.0 months; p=0.022), contralateral hilar (19.8 months; p=0.021), supraclavicular LNM (15.1; p=0.003) [ipsilateral supraclavicular LNM (15.1 months; p=0.009) and contralateral supraclavicular LNM (13.8 months; p=0.007)]. There were no significant differences in median OS between the different N3-categories (p=0.84). Multivariate analyses adjusting for established prognostic factors in lung cancer (gender, age, PS, weight-loss and appetite loss) and treatment showed that N3-disease (HR 2.30; 95% CI=1.51-3.48; p<0.001), supraclavicular LNM (HR 1.67; 95% CI=1.01-2.77; p=0.046) and contralateral mediastinal LNM (HR 2.34; 95 % CI = 1.55-3.51; p<0.001) remained significant prognostic factors.
Conclusion:
Patients with N3-disease had inferior OS to those with N0-2 disease. All subcategories of N3 had inferior OS in the univariate analyses, while supraclavicular and contralateral mediastinal LNM remained significant in the multivariate analyses. Patients with supraclavicular LNM had similar OS as other N3 subcategories.
