Author of

• 12701

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  P3.12 - Poster Session 3 - NSCLC Early Stage (ID 206)

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

  • 12714

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    P3.12-013 - Radical treatment of synchronous oligometastatic non-small cell lung carcinoma (NSCLC): patient outcomes and prognostic factors. (ID 2315)

    09:30 - 09:30  |  Author(s): D. Toguri
    • Abstract

    Background
    In general, metastatic NSCLC has a poor prognosis and systemic therapy is the cornerstone of treatment. However, extended survival has been reported in some patients presenting with a limited number of metastases, termed oligometastatic disease. The goal of this study was to assess outcomes for patients presenting with NSCLC and synchronous oligometastases, treated with radical intent, and to determine predictors of long-term survival.

    Methods
    A retrospective chart review was undertaken at two cancer centres, on patients with NSCLC presenting with 1-3 metastasis, who received radical intent treatment (surgery and/or radiotherapy (RT) ± chemotherapy) to the primary lung tumor including the pathological regional nodes and all sites of metastatic disease. Overall survival (OS), progression-free survival (PFS) and survival after first progression (SAPF) were evaluated. Recursive partitioning analysis (RPA) was performed based on significant factors from univariable analysis to identify different risk groups.

    Results
    Between 1999 and 2012, 61 patients were treated with a total of 74 metastases. Median follow-up was 26 months. Patients had a median age of 62 years, a median performance status of 1 and intrathoracic disease that was predominately stage III (n=38). The majority of patients had a solitary metastasis (n=50). Common sites of metastases were brain (n=47 lesions), bone (n=11), adrenal (n=4), contralateral lung (n=4) and extrathoracic lymph nodes (n=4). Treatment of the primary tumor consisted of RT ± chemotherapy in 52 patients and surgery alone or in combination with other modalities in 9 patients. Metastases were treated with stereotactic or high-dose RT (n=39) or surgery (n=22). Median OS was 13.5 months, 2-year OS was 38%. Median PFS was 6.6 months and median SAFP was 4.9 months. Predictors of improved survival were surgery for the primary lung tumor (p<0.001), and intrathoracic PTV size in patients receiving RT (p<0.03). These factors were used for RPA (Figure 1). No significant differences in outcomes were observed between the two centers. Figure 1 Figure 1. RPA flowchart for OS showing characteristics of risk groups (A) with accompanying Kaplan-Meier curves of OS by RPA risk groups (B)

    Conclusion
    Radical treatment of selected NSCLC patients presenting with 1-3 synchronous metastases can result in favorable 2-year survival, although progression in the first year was common. Outcomes were strongly associated with intra-thoracic disease status: patients with small radiotherapy treatment volumes or resected disease had the best OS. Prospective clinical trials, ideally randomized, should evaluate the role of radical treatment strategies in patients with oligometastases.