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O.C. Guler



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    MO25 - NSCLC - Combined Modality Therapy II (ID 112)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Mesothelioma
    • Presentations: 1
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      MO25.08 - Impact of Pretretment Leukocytosis on Prognosis in Locally Advanced Non-Small Cell Lung Cancer Patients Treated with Concurrent Chemoradiotherapy (ID 1831)

      11:15 - 11:20  |  Author(s): O.C. Guler

      • Abstract
      • Slides

      Background
      In this study, impact of high pretreatment white blood cell count (WBCC) on survival outcomes in locally advanced non-small cell lung cancer (LA-NSCLC) patients treated with concurrent chemoradiotherapy (CRT) was investigated.

      Methods
      Medical records of LA-NSCLC patients treated with definitive CRT at our department between dates January 2007 and December 2011 were retrospectively evaluated. All patients received 60-66 Gy thoracic radiotherapy concurrently with 1-3 cycle cisplatin-vinorelbine/taxane (q21) regimen chemotherapy. Patients were divided into two groups according to pretreatment basal WBCC: Group1: normal (4.000-11.000) and Group 2: high (>11.000). These two groups are compared in terms of overall survival (OS), and progression-free survival (PFS).

      Results
      Pretreatment characteristics of 718 patients were given in Table 1. At a median follow-up of 23.2 months (range 8.8-44.6), median OS and PFS for whole group were 20.6 (%95 CI: 19.3-21.9) and 9.9 months (%95 CI: 9.4-10.1), respectively. On comparative survival analyses, patients with high pretreatment WBCC had inferior OS (22.8 vs.14.7 months; p<0.001) and PFS (10.4 vs. 7.0 months; p<0.001) than those with normal WBCC. On univariate analyses, T-stage (T1-2 vs. 3-4; p=0.035), N-stage (N2 vs. N3; p=0.002), and pretreatment WBCC (4.000-11.000 vs >11.000; p<0.001) were the significant prognostic factors. These factors also retained their significance on multivariate analyses as well (p<0.05 for each). Table. Pretreatment patients characteristics

      Characteristics Whole Group (n=718) Group 1 (n=555) Group 2 (n=163) P value
      Median age (Years) Range 54.0 31-69 53 33-64 54 31-69 0.28
      Sex [N,(%)] Female Male 246 (34.3) 472 (65.7) 51 (7.1) 112 (15.6) 195 (27.2) 360 (50.1) 0.39
      Performance Status [N,(%)] ECOG 0 ECOG 1 314 (43.7) 404 (56.3) 73 (10.2) 90 (12.5) 241 (36.6) 314 (43.7) 0.78
      Histology [N,(%)] Squamous cell Adenocancer 388 (54.0) 330 (46.0) 92 (12.8) 71 (9.9) 296 (41.2) 259 (36.1) 0.53
      TN stage T1N3 T2N3 T3N3 T4N2 T4N3 73 (10.2) 115 (16.0) 292 (40.7) 123 (17.1) 115 (16.0) 17 (2.4) 26 (3.6) 51 (7.1) 28 (3.9) 41 (5.7) 56 (7.8) 89 (12.4) 241 (33.6) 95 (13.2) 74 (10.3) 0.11

      Conclusion
      Worse survival outcomes observed in patients with pretreatment WBCC above the reference limits suggest that pretreatment WBCC may be a potentially cheap and relevant independent prognostic factor that can be used besides other well-known factors to predict treatment outcomes in LA-NSCLC patients treated with definitive CRT.

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    P1.09 - Poster Session 1 - Combined Modality (ID 212)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 2
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      P1.09-007 - Prognostic Value of Number of Chemotherapy Cycle in Stage IIIB Non-small Cell Lung Cancer Patients Treated with Thoracic Radiotherapy and Concurrent Cisplatin-Vinorelbine (ID 937)

      09:30 - 09:30  |  Author(s): O.C. Guler

      • Abstract

      Background
      The study was aimed to evaluate association between number of chemotherapy (CT) cycles and prognosis in stage IIIB non-small cell lung cancer (NSCLC) patients treated with thoracic radiotherapy (TRT) and concurrent CV CT protocol given in 1-3 cycles according to the toxicity or patient preference.

      Methods
      A total of 475 18-70 years old stage IIIB NSCLC patients, who received 60-66 Gy TRT concurrently with at least 1 cycle CV (q21) regimen between January 2007 and December 2011 were retrospectively evaluated. Primary end point was overall survival (OS), and secondary end points were progression-free survival (PFS) and locoreginal PFS (LRPFS).

      Results
      Median follow-up time was 21.7 months (range 17-24.1). Histolopathologic subtype was squamous cell in 51.8%, and adenocarcinoma in 48.2% of cases. Treatment-related mortality was reported in 6 (1.3%) patients. There was no grade-4 non-hematological toxicity but grade-4 hematological toxicity was observed in 59 (12.4%) patients. Respective grade-3 non-hematological and hematological toxicity rates were 14.5% (n=69) and 24.6% (n=117), with leukopenia (9.3%) and esophagitis (17.3%) being the most common toxicities. Median OS, PFS and LRPFS for whole group were 20.7 (%95 CI: 19.4-22.0), 9.9 (%95 CI: 9.9-10.4) and 13.4 months (%95 CI: 12.6-14.2), respectively. Comparative median OS, PFS and LRPFS results for groups receiving 1 (n=44), 2 (n=68) and 3 (n=363) cycles of chemotherapy were 13.2 vs. 19.3 vs. 21.9 months ( p≤0.001), 6.1 vs. 9.7 vs. 10.5 months (p≤0.001), 6.6 vs. 12.8 vs.14.2 months ( p≤0.001), respectively. For all survival parameters, there were significant difference between patients receiving 1 cycle and 2 or 3 cycles of chemotherapy (p<0.05 for each) but there was no difference between those receiving 2 and 3 cycles of chemotherapy (p≥0.05 for each). T-satge (T1-2 vs T3-4) and N-stage (N2 vs N3) were the other factors influencing OS (p<0.05 for each) on univariate analyses. However, only T-stage (p=0.004) and Number of chemotherapy cycles (p≤0.001) retained prognostic significance on multivariate analyses.

      Conclusion
      Our results revealed that CV protocol was a relatively well-tolerated chemotherapy regimen given concurrently with TRT in stage IIIB NSCLC cases, and number of chemotherapy cycles than could be given during TRT course was an important prognostic indicator in such patients. Although results of randomized trials are needed, findings of superior survival in cases receiving 2 or 3 cycles of chemotherapy during TRT and similar survival results between 2 and 3 cycles suggest that 2 cycles of chemotherapy may potentially reduce toxicity rates, which results in increased treatment tolerability and quality of life, without compromising efficacy of treatment.

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      P1.09-014 - Prognostic Value of Age in Patients Receiving Concurrent Chemoradiotherapy with Diagnosis of Stage IIIB Non-Small Cell Lung Cancer (ID 1818)

      09:30 - 09:30  |  Author(s): O.C. Guler

      • Abstract

      Background
      In this study, prognostic role of age in stage IIIB non-small cell lung cancer (NSCLC) patients treated with definitive concurrent chemoradiotherapy (CRT) was investigated.

      Methods
      Medical records of 942 18-70years old stage-IIIB NSCLC patients treated between January 2007 and December 2011 were retrospectively evaluated. Patients received 60-66 Gy radiotherapy concurrently with 1-3 cycle cisplatin-based (q21) chemotherapy. Patients were divided into groups [Group 1= ≤45 years(N=145), Group 2= 45-70(N=680) and Group 3=70-80(N=117)] according to the cut-off ages defined in the literature. Moreover, a further age cut-off point that might potentially influence survival was researched from ROC analysis, and comparatively analyzed with other factors. Primary end point was the evaluation of association between treatment duration and overall survival (OS), and secondary end points were progression-free survival (PFS) and locoregional PFS (LRPFS).

      Results
      Median follow-up for alive patients was 30.8 months (range 17.4-38.2), there was no statistically significant difference between groups in terms od demographic characteristics (p>0.05). Overall treatment was well-tolerated, and treatment-related mortality was reported in only 7 (0.7%) cases, which was not different between groups (%1.4 vs. %0.6 vs. 0.9; p=0.87). The most common grad 3-4 hematological and non-hematological toxicities were leukopenia (%37.3; %35.9 (n=52) vs. %36.2 (n=243) vs. %45.3 (n=53); p=0.26), and eosophagitis (%20.6 (n=194); %17.2 (n=25) vs. %20.7 (n=141) vs.%23.9 (n=28); p=0.36), respectively. Median OS for whole group was 23.6 months (%95 CI: 22.8-24.3). Results of comparative survival analyses between 3 groups were given in Table, and there was no statistically significant survival difference between groups in all survival measures. Moreover, no significant age cut-off that might be used to evaluate age as prognostic factor could be determined from ROC analyses. Table: Comparative survival analyses

      Survival Group 1 ≤45 years (N=145) Group 2 45-70 (N=680) Grup 3= 70-80 (N=117) P
      Overall Survival Median (%95 CI) 2 years 3 years 4 years 5 years 24.8 (22.3-27.3) 51.9 38.0 24.2 24.2 23.4 (22.5-24.3) 46.8 30.2 23.2 19.2 21.2 (17.3-25.1) 47.5 27.6 14.3 14.3 0.32
      Locoregional Progression-free Survival Median (%95 CI) 2 years 3 years 4 years 5 years 15,7 (12,2-19,2) 33.3 25.5 12.2 12.2 14,7 (14,2-15.2) 22.1 18.5 15.6 12.6 14.7 (13,9-15.5) 27.4 26.4 9.2 9.2 0.13
      Progression-free Survival Median (%95 CI) 2 years 3 years 4 years 5 years 12.0 (9.9-14.1) 24.3 18.2 11.2 11.2 10.6 (10.1-11.1) 17.5 15.1 13.4 12.5 10.6 (10.0-11.1) 20.3 18.2 7.3 7.3 0.18

      Conclusion
      Results of this study has demonstrated that age was not a prognostic parameter that could be used alone to predict outcomes in stage IIIB NSCLC treated with CRT. The observation that patients >70 years old could also tolerate aggressive CRT protocols, treatment of elderly patients with good performance status and no comorbidity with protocols similar to younger counterparts is recommended

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    P2.08 - Poster Session 2 - Radiotherapy (ID 198)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Radiation Oncology + Radiotherapy
    • Presentations: 1
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      P2.08-007 - Impact Surgical Resection and Radiosurgery Directed To Brain Metastasis on Survival Outcomes in Non-Small Cell Lung Cancer Patients with Synchronous Single Brain Metastasis (ID 1848)

      09:30 - 09:30  |  Author(s): O.C. Guler

      • Abstract

      Background
      Aim of this study was to compare surgical resection and radiosurgical treatment modalities directed to brain metastasis (BM) in terms of survival outcomes in newly diagnosed non-small cell lung cancer (NSCLC) patients with synchronous single brain metastasis (SSBM).

      Methods
      Medical records of medically fit NSCLC patients with SSBM treated at our department were retrospectively evaluated. A total of 64 patients were staged with PET-CT besides conventional staging tools. TRT to a total dose of 66 Gy in 2 Gy fx was delivered with 2 cycles of concomitant cisplatin –based chemotherapy (CT) following surgery+30 Gy whole-brain RT (WBRT) (n:33) or 30 Gy WBRT+stereotactic radiosurgery (SRS) (n:31) for their BM.

      Results
      Pretreatment patient characteristics were given in Table. Whole study population could complete planned treatment to their BM and thoracic primaries. At median 20.7 months (7.1-58.7) of follow-up, Median overall (OS), neurological progression-free (NPFS), locoregional progression-free (LRPFS) and progression-free survival (PFS) were 23.4, 22.8, 14.9, ve 9.4 months, respectively. There was no statistically significant survival difference between two groups (p>0.05 for each survival parameter) (Figure 1). On univariate analyses, patients with ECOG performance status of 0-1 (p<0.001), younger than median 50 years (p=0.031) and with no weight loss (p=0.001) revealed superior OS. On multivariate analyses performed with these factor, all factors except age retained their independent prognostic value (p<0.05 for each parameter). Table 1. Pretreatment patient characteristics Figure 1Figure 2

      Conclusion
      Results of this study has shown that, in line with the literature, surgical or radiosurgical treatment modalities directed to SSBM in NSCLC patients could not demonstrate any superiority over each other. Therefore, management of BM should be tailored according to the facilities available, and patient or disease-specific conditions. Moreover, although larger prospective data are needed, survival outcome in such patients similar to locally advanced patients indicates the potentially curative role of definitive CRT.

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    P2.09 - Poster Session 2 - Combined Modality (ID 213)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P2.09-009 - Impact of Change in Hemoglobin Levels During Treatment on Prognosis in Non-anemic Locally Advanced Non-Small Cell Lung Cancer Patients Treated with Concurrent Chemoradiotherapy (ID 1836)

      09:30 - 09:30  |  Author(s): O.C. Guler

      • Abstract

      Background
      Purpose of this study was to evaluate the association between change in hemoglobin (Hb) levels during treatment and disease control and survival in locally advanced non-small cell lung cancer (LA-NSCLC) patients treated with concurrent chemoradiotherapy (CRT).

      Methods
      Medical records of 368 LA-NSCLC patients, who had been treated with definitive CRT at our department between dates January 2007 and December 2011, and whose pretreatment Hb levels were ≥12.0 g/L, and who had at least 3 Hb measurements during CRT, were retrospectively evaluated. All patients received 60-66 Gy thoracic 3-dimentional conformal radiotherapy concurrently with 1-3 cycle cisplatin/carboplatin-vinorelbine/taxane (q21) doublet chemotherapy. For all analyses, patients were divided into groups according to their nadir Hb level, percent Hb change, development of anemia (Hgb<12) and nadir Hb cut-off defined from ROC analysis. Primary end point was overall survival (OS), and secondary end points were progression-free survival (PFS) and locoreginal PFS (LRPFS).

      Results
      At a median follow-up of 24.7 months (range 19.7-27.5), Median OS, PFS and LRPFS for whole group were 23.8 (%95 CI=22.8-24.8), 11.7 (%95 CI=11.0-12.5) and 15.3 months (%95 CI=14.7-15.9), respectively. During CRT course, 138(37.5%) patients developed anemia, and median OS, PFS, and LRPFS were significantly worse in these patients [(27.3 vs. 18.3; p<0.001), (12.7 vs. 9.2; p<0.001), and (16.4 vs. 11.2 months; p<0.001)]. While there was no statistically significant survival difference according to median nadir Hb level and % Hb change, patients with Hb levels above the cut-off point defined from ROC curves (12.4 g/L) revealed better OS (27.7 vs. 20.4; p<0.001), PFS (12.8 vs. 10.2; p<0.001) and LRPFS (16.4 vs. 13.8 months; p<0.001). On multivariate analyses, only these two factors found to be independent prognostic factors (p<0.001 for Hb > vs. < 120 g/L, p<0.03 for Hb> vs.

      Conclusion
      Results of this study has shown that 37.5% NSCLC patients with normal pretreatment Hb levels had developed anemia during the course of CRT, which was found to be a worse prognostic factor independent from other co-existing factors in terms of locoregional tumor control and survival outcome.

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    P3.09 - Poster Session 3 - Combined Modality (ID 214)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Combined Modality
    • Presentations: 1
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      P3.09-009 - Survival Outcome in Stage IIIB Non-Small Cell Lung Cancer Patients Younger than 45 Years: Retrospective Analysis of 145 Patients. (ID 1835)

      09:30 - 09:30  |  Author(s): O.C. Guler

      • Abstract

      Background
      Purpose of this study was to assess clinical outcomes of concurrent chemoradiotherapy (CRT) in Stage IIIB non-small cell lung cancer (LA-NSCLC) patients younger than 45 treated with concurrent chemoradiotherapy (CRT).

      Methods
      Medical records of 145 ≤45 years old patients out of 942 LA-NSCLC patients, who had been treated with definitive CRT [60-66 Gy thoracic radiotherapy (TRT) concurrently with 1-3 cycle cisplatin-based doublet (vinorelbine/docetaxel/etoposite/gemcitabine) chemotherapy] at our department between dates January 2007 and December 2011 were retrospectively evaluated. . Primary end point was overall survival (OS), and secondary end points were progression-free survival (PFS) and locoreginal PFS (LRPFS).

      Results
      At the time of analyses, 58 (40%) patients were alive, and median follow-up for these patients was 30.5±11.2 months. For whole study group, median, 3- and 4-year OS, LRPFS and PFS were 24.8 months, 38% and 24%, 15.7 months, 26.3% and %18.9, and 12 months, 18.2% and 11.2%. On univariate analyses, CRT duration (≤50 vs. >50 days; p<0.001), pretreatment anemia (Hb<12 g/dl vs. ≥12; p<0.001) were significantly associated with survival while there was a statistical trend for nodal stage (N2 vs N3; p=0.09). On multivariate analyses, longer CRT duration and pretreatment anemia retained their prognostic significance.

      Conclusion
      Median OS of 24.8 months for younger stage IIIB NSCLC patient treated with CRT is promising, and superior OS in patients with no pretreatment anemia and in patients completing their CRT earlier than 50 days suggest that pretreatment anemia should be corrected and all preventive measures should be performed to complete CRT at planned period of time.