Author of

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

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Combined Modality
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12575

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    P3.09-002 - I want it all! The better outcome of patients with locally advanced non-small cell lung cancer receiving chemoradiation followed by surgery over any other combination of inductive chemotherapy, radiation or surgery (ID 298)

    09:30 - 09:30  |  Author(s): E. Garcia-Alonso
    • Abstract

    Background
    Half of Non-small cell lung cancers are diagnosed in locally advanced stage (LA-NSCLC) and warrant multidisciplinary treatments including chemotherapy, radiation, and surgery (S) in a not well-defined combination and sequence. We compared tolerance and effectiveness of different combos of inductive chemo (iCT) or chemoradiotherapy (iCRT) followed by S or consolidative radiation (RT)

    Methods
    We retrospectively reviewed 108 consecutive LA-NSCLC diagnosed in our center between October-2004 and June-2012 and treated with: 1) iCRT+S (N= 24); 2) iCT+S (N= 31); 3) iCRT+RT (N= 36); 4) iCT+RT (N= 17). Their tolerance, response, and outcome were statistically compared. Survival of five patients that progressed during inductive therapy was not analyzed

    Results
    Mean age of the patients was 66.2 years-old, 92% were male, and 85.1% ECOG-0. Histology was squamous carcinoma in 71.3%, non-specified NSCLC in 15.7%, and adenocarcinoma in 12%. iCT included platin-doublets with taxanes, vinorelbine, and gemcitabine. CBDCA-combinations were commonly used in elderly patients (15.6% vs. 31.8%, p= 0.001). Grade 3-4 toxicity was observed in 14.8% of inductive therapies, without significant differences between iCT and iCRT arms (p= 0.976). No patient interrupted therapies due to toxicity. Progression rate was higher with iCT than iCRT (8.3% vs. 0; p= 0.023). S was performed in 51 patients (pneumonectomy 30%, bi/lobectomy 56%). Severe S complications appeared in 13.7% of cases. Three patients in the iCRT+S arm died due to early postoperative complications. Complete pathologic responses were higher with iCRT than iCT (25% vs. 11.5%, p= 0.049). Resected patients presented better disease free (DFS) and overall survivals (OS) than those definitively radiated (27.9 vs. 12 months, p= 0.000; and 37.8 vs. 25.9 months, p= 0.009). Higher DFS and OS was found among patients of the iCRT+S arm (p= 0.000 and p= 0.049, respectively)

    Conclusion
    Those LA-NSCLC that achieved S after inductive therapy presented a better outcome that those non-resected. iCRT+S was tolerable, feasible, and obtained the higher response and survival rate of our series, although these results are biased by the better prognosis of resectable patients. Anyway, prospective trials are warranted to confirm the benefits of triple multidisciplinary approach. Figure 1. DFS and OS Kaplan-Meier curves of patients according to the treatment arm. Figure 1