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X. Xu
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P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.03-010 - Adjuvant Chemotherapy plus Radiotherapy is Superior to Chemotherapy in Surgically Treated IIIA N2 Non-Small-Cell Lung Cancer (ID 2831)
09:30 - 09:30 | Author(s): X. Xu
- Abstract
Background:
The role of addition radiotherapy for resected stage IIIA (N2) non-small cell lung cancer (NSCLC) in the setting of standard adjuvant chemotherapy remains controversial.
Methods:
A comprehensive search of PubMed, Embase, Medline database (last search updated in March 2015) for relevant studies comparing patients with stage IIIA (N2) NSCLC undergoing resection after treatment with adjuvant chemotherapy alone (POCT) or adjuvant chemoradiotherapy (POCRT) was conducted. Hazard ratios (HR) were extracted from these studies to give pooled estimates of the effect of POCRT on overall survival (OS) and disease free survival (DFS).
Results:
A total of six studies including two randomized controlled trials (RCTs) and four retrospective studies were enrolled in this meta-analysis. There were 6 studies that met criteria for analysis, including 2 RCTs and 4 retrospective reviews. The meta-analysis enrolling all studies (5172 cases) demonstrated an OS benefit to POCRT versus POCT (HR 0.87, 95% confidence interval [CI] 0.79 to 0.96, p = 0.006). DFS was investigated in four studies including 2 RCTs and 2 retrospective reviews. Unfortunately, there was no significant difference in DFS of two groups for the combined HR for PFS was 0.86 (95% CI: 0.70-1.06; p = 0.158). The sub-group analysis performed on two RCTs (n = 172 patients) demonstrated no benefit from adding radiation in neither OS (HR 0.72, 95% CI 0.49 to 1.06, p = 0.094) nor DFS (HR 1.45, 95% CI 1.00 to 2.09, p = 0.047).
Conclusion:
Compared with POCT, POCRT had a benefit for OS but not DFS in the patients with IIIA-pN2 NSCLC. Considering the relatively small sample size of most studies and only included two RCTs, caution should be taken when adopting the conclusions. Future RCT to investigate the role of POCRT after surgical resection of stage IIIA (N2) NSCLC is warranted.
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P2.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 213)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.03-012 - Neoadjuvant Chemoradiotherapy or Chemotherapy Followed by Surgery Is Superior to That Definitive Chemoradiation in Stage IIIA (N2) NSCLC (ID 2628)
09:30 - 09:30 | Author(s): X. Xu
- Abstract
Background:
Whether neoadjuvant chemoradiotherapy or chemotherapysurgery followed by surgery is superior to that followed by definitive radiotherapy in Stage IIIA (N2) NSCLC remains controversial.
Methods:
A literature search was performed in the Pubmed, Embase, Medline database (last search updated in March 2015) and a systematic review and meta-analysis of available data was conducted.
Results:
A total of nine studies including five randomized controlled trials and four retrospective studies were enrolled in this meta-analysis. A significant homogeneity (χ2=49.62 ,p=0.000，I[2]=81.9% ) between the four studies with a total of 11948 selected cases was detected between the nine studied investigated overall survival (OS), the random effects model was used to conduct meta-analysis. The combined hazard ratio (HR) of for was 0.65 (95% confidence interval [CI]: 0.60-0.71; p=0.000). Subgroup analysis was investigated according to study design and extent of resection. We observed a statistically significantly better outcome after lobectomy (combined HR: 0.52; 95% CI: 0.47-0.58; p =0.000) than after pneumonectomy (combined HR: 0.82; 95% CI: 0.69–0.98; p=0. 028). Unfortunately, there was no significant difference in randomized controlled studies for the combined HR was 0.94 (95% CI: 0.81-1.09; p = 0. 440).
Conclusion:
Neoadjuvant chemoradiotherapy or chemotherapy followed by surgery is superior to that followed by definitive radiotherapy, particularly in patients with lobectomy. Further study to investigate randomized trial be performed comparing chemoradiation followed by lobectomy vs. definitive chemoradiation in patients with stage IIIA disease is urgently needed.
