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U. Selek



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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): U. Selek

      • 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: 3
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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): U. Selek

      • 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): U. Selek

      • 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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      P1.09-015 - Impact of Pretretment Leukocytosis on Prognosis in Locally Advanced Non-Small Cell Lung Cancer Patients Treated with Concurrent Chemoradiotherapy (ID 1843)

      09:30 - 09:30  |  Author(s): U. Selek

      • Abstract

      Background
      Purpose of this study was to evaluate the association between pretreatment thrombocyte count (TC) and prognosis in locally advanced non-small cell lung cancer (LA-NSCLC) patients treated with concurrent chemoradiotherapy (CRT).

      Methods
      Medical records of 792 LA-NSCLC patients, who had been treated with definitive CRT at our department between dates January 2007 and December 2011, and whose pretreatment TC values are available, 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 two groups according to their pretreatment TC: Group-1: normal (130.000-400.000; n=639) and Group-2: high (>400.000; n=153). Primary and secondary end points were overall survival (OS), and progression-free survival (PFS), respectively.

      Results
      At a median follow-up of 23.1 months (range 18.8-24.6), Median PFS and OS for whole group were 10.1 (%95 CI: 9.7-10.5) and 20.9 months (%95 CI: 20.9-22.9), respectively. On comparative survival analyses, patients with high pretreatment TC had inferior OS (23.2 vs. 15.6 months; p≤0.001) and PFS (10.6 vs. 7.8 months; p<0.001) than those with normal TC. Similarly, 3-years OS was significantly lower in Group-2 patients (8.9 vs. 33%, p<0.001). TC cut-off value determined from ROC curve analysis was 278.000, and median OS (18.7 vs. 24.5 months; p<0.001 and PFS (9.1 vs. 11.3 months, p<0.001) was significantly lower in patients with TC above this cut-off point. On univariate analyses, T-stage (T1-2 vs. 3-4), N-stage (N2 vs. N3), pretreatment TC (130.000-400.000 vs. >400.000), and ROC TC cut-off (<278.000 vs. ≥278.000) were the significant prognostic factors (p<0.05 for each), which retained their significance on multivariate analyses as well (p<0.001, 0.022, <0.00, 0.01, respectively).

      Conclusion
      Results of this study has shown that pretreatment TC may be a relevant and independent prognostic factor that can potentially be used besides other well-known factors to predict treatment outcomes in LA-NSCLC patients treated with definitive CRT.

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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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      P2.08-006 - Efficacy of Single Dose 8-Gy Palliative Chest Irradiation in Pain Palliation of Patients with Locoregionally Recurrent Stage IV Non-Small Cell Lung Cancer (ID 938)

      09:30 - 09:30  |  Author(s): U. Selek

      • Abstract

      Background
      To investigate the efficacy of single dose 8-Gy palliative chest re-irradiation (PCRI) in metastatic non-small cell lung cancer (M-NSCLC) patients with painful recurrences in previously irradiated thoracic region.

      Methods
      Clinical data of 63 M-NSCLC patients, who received single dose 8-Gy PCRT due to painful thoracic recurrences from February 2007 to June 2010 were retrospectively analyzed. All patients had previously received upfront definitive 60-66 Gy concurrent chemoradiotherapy (C-CRT), and 52 of them had also received salvage chemotherapy. Primary endpoint was change in visual analogue score (VAS), and secondary endpoints were time to lowest VAS record and duration of pain control.

      Results
      Treatment was well tolerated with only 3 (4.8%) grade III radiation-induced pneumonitis. For all patients median, 1-, 2-year survival were 9.2 months, 28.4%, and 12.3%. Median pre-PCRI and minimum achievable post-PCRI VAS values were 6.7 (range: 5-8) and 3.4 (range: 0-8), and the decline in VAS values was statistically significant (p<0.001). Objective response defined as reduction of at least 2 points in VAS value was achieved in 54 (85.7%) patients. Median time to lowest VAS and duration of pain control were; 27 (95% CI: 21 - 33) days and 7.1 (95% CI: 6.3 - 7.9) months, respectively.

      Conclusion
      Single dose 8-Gy PCRI is safe and highly efficient in palliating moderate to severe pain in locoregionally recurrent M-NSCLC patients, who have previously received upfront definitive C-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): U. Selek

      • 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: 3
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      P3.09-008 - Prognosis of Stage III Non-Small Cell Lung Cancer Patients Initially Presenting with Superior Vena Cava Syndrome Treated with Partially Accelerated Definitive Concurrent Chemoradiotherapy (ID 1814)

      09:30 - 09:30  |  Author(s): U. Selek

      • Abstract

      Background
      To retrospectively investigate the prognosis of locally advanced non-small cell lung cancer (LA-NSCLC) patients initially presenting with superior vena cava syndrome (SVCS) following partially accelerated definitive concurrent chemoradiotherapy (C-CRT).

      Methods
      Forty-seven LA-NSCLC patients presented with SVCS between June 2007 and December 2011 were included. All patients received an initial daily 4 Gy radiotherapy (RT) followed by weekly cisplatin-based chemotherapy given concurrently with 2 Gy daily RT for additional 26 fractions, which corresponds to a biologically equivalent dose (BED10) of 79.2 Gy. Primary endpoint was overall survival (OS).

      Results
      Median follow-up time was 20.3 months for whole cohort, and 37.4 months for surviving patients. Median age was 63 years. Squamous cell- and adenocarcinoma rates were 54 and 46%, respectively. Stage distribution was 29.8% stage IIIA and 70.2% stage IIIB. Treatment was relatively well tolerated. All patients were able to receive planned RT, and 39 (83%) received 4 or 5 courses of prescribed chemotherapy. There were no treatment related deaths at acute phase while 8 (17%) grade 4 hematologic toxicity was reported, with no grade 4 non-hematologic toxicity. At long term 2 patients died of tracheoesophageal fistula and caval rupture. Median, 2-, and 3-year OS were 19.4 months, 36.2%, and 25.5%, respectively. On univariate analyses; cause of SCVS (nodal vs. primary tumor; p<0.001), status of SVC (infiltrated vs. compressed; p<0.001), and tumor stage (IIIA vs. B; p<0.03) were the factors significantly associated with prognosis. Of these, cause of SCVS (p<0.001) and status of SVC (p<0.001) retained their significance on multivariate analyses.

      Conclusion
      Partially accelerated C-CRT regimen utilized here is reasonably safe and efficient in LA-NSCLC patients initially presenting with SVCS. Present survival rates, which are almost equivalent to those reported for similarly staged patients without SVCS suggest treatment of such patients with aggressive C-CRT protocols.

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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): U. Selek

      • 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.

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      P3.09-010 - Long Treatment Duration is Associated with Poor Prognosis in Patients Receiving Concurrent Chemoradiotherapy with The Diagnosis of Stage IIIB Non-Small Cell Lung Cancer (ID 1844)

      09:30 - 09:30  |  Author(s): U. Selek

      • Abstract

      Background
      Aim of this study is to investigate the relationship between the treatment duration on prognosis in stage IIIB non-small cell lung cancer (NSCLC) patients treated with definitive concurrent chemoradiotherapy (CRT).

      Methods
      Medical records of 824 18-70 years old stage IIIB NSCLC patients treated at our department between dates January 2007 and December 2011 were retrospectively evaluated. Patients received 60-66 Gy thoracic radiotherapy concurrently with at least 1 cycle cisplatin-vinorelbine/docetaxel (q21) regimen chemotherapy. 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 locoreginal PFS (LRPFS).

      Results
      At a median follow-up of 22.8 months (range 17.4-25.2), Median OS, PFS and LRPFS for whole group were 21.2 (%95 CI: 20.2-22.2), 9.9 (%95 CI: 9.4-10.3) and 13.7 months (%95 CI: 13.1-14.3), respectively. The most significant cut off point for CRT duration defined in ROC (receiver operating characteristic) curve analysis was 50.5 days, and patients were dichotomized into two groups; namely Group 1: ≤50 (n=420) and Group 2: ≥ 50 (n=404). On comparative survival analyses, patients completing their CRT in shorter period of time revealed superior OS (26.6 vs.15.5 months; p<0.001), PFS (12.8 vs.7.7 months; p<0.001), and LRPFS (16.4 vs.10.2 months; p<0.001) than the others. Duration of CRT retained its significant association with OS, PFS, and LRPFS on multivariate analyses (p<0.001).

      Conclusion
      Results of this study has demonstrated that completion of CRT in longer than 50 days was associated with significantly shorter survival. Therefore, treatment delays due to religious or official holidays should be avoided, and all comprehensive palliative measures should be performed in order to minimize treatment-related toxicities that might potentially prevent shorter delivery of CRT.