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S. El Sharouni
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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-051 - Determinants of Sequential versus Concurrent Chemoradiotherapy in Stage III Non-Small Cell Lung Cancer Patients (ID 1205)
09:30 - 09:30 | Author(s): S. El Sharouni
- Abstract
Background:
Concurrent chemoradiotherapy (CCRT) is considered the standard treatment regimen in patients with inoperable stage III non-small cell lung cancer (NSCLC). Sequential chemoradiotherapy (SCRT) is recommended in patients who are deemed unfit to receive CCRT. As this selection criterion is not very explicit, the ‘personalized’ choice for either CCRT or SCRT is mainly dependent on the multidisciplinary team and treating physician’s judgment. Consequently, this may result in a variation of treatment policies across hospitals/radiotherapy (RT) departments. In this study, we investigated the ratio CCRT/SCRT in eight RT departments in the Netherlands. Furthermore, we explored which patient and disease characteristics determined the choice for SCRT compared to CCRT.
Methods:
Data were derived from the Dutch Lung Radiotherapy Audit (DLRA). Within the DLRA, lung cancer patients undergoing a curative intent treatment are prospectively registered with respect to patient and disease characteristics, diagnostics and treatment. For this study, from eight out of 21 Dutch RT departments, patients with stage III NSCLC undergoing chemoradiotherapy in 2014 were selected. CCRT was defined as ≤ 50 days between the start of chemotherapy and the start of radiotherapy. Furthermore, RT had to start before the end of the last chemotherapy in CCRT. Patients with < 150 days between treatments were scored as undergoing SCRT. Differences in patient and disease characteristics between CCRT and SCRT were tested with independent samples t-tests (for continuous variables) and with chi-square tests (for categorical variables). A multivariate logistic regression model was constructed to determine patient and disease characteristics associated with the choice for SCRT, using a backward selection procedure. Odds ratios (OR) with 95% confidence intervals (CI) are reported.
Results:
In total, 453 stage III NSCLC patients (mean age 65.4 years, 56.5% male) were registered. Of those, 351 (77.5%) patients underwent CCRT and 102 (22.5%) patients received SCRT. The proportion of patients treated with CCRT ranged from 51% to 89% across RT departments. Gender, smoking, gross target volume (GTV), performance score (PS), lung function, Charlson comorbidity index and tumor location were not significantly associated with SCRT in the multivariate model. Conversely, older age (OR 1.05 [95%CI 1.03-1.09]), histology (large cell carcinoma vs adenocarcinoma [OR 0.42 CI 0.19 to 0.97]) and cN-stage (N3 vs N0-1 [OR 5.71 {95%CI 2.10-15.50}]) were significantly associated with SCRT.
Conclusion:
In this selected group of registered NSCLC patients, a large variation was observed in the proportion of stage III NSCLC patients treated with CCRT, ranging from 51% to 89% across RT departments. Surprisingly, PS and comorbidity index (as indicators of a patients’ physical fitness) were not significantly different in CCRT or SCRT patients while age and cN-stage were. Based on the analyzed patient and disease characteristics, it is currently unclear why patients treated with SCRT were not eligible for CCRT.
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P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.03-029 - No Inferior Outcomes after Stereotactic Radiotherapy for Stage I and II NSCLC Compared with Surgery (ID 134)
09:30 - 09:30 | Author(s): S. El Sharouni
- Abstract
Background:
Surgical resection is the treatment of first choice for patients who are diagnosed with stage I and II non-small cell lung cancer (NSCLC). However, last years, stereotactic body radiotherapy (SBRT) has shown to be a good alternative treatment, especially for the elderly or for patients with a poor pulmonary function. We compared the overall survival (OS), progression free survival (PFS) and locoregional and distant recurrence between patients with stage I and II NSCLC treated with SBRT or surgery.
Methods:
Patients who were diagnosed with stage I and II NSCLC between 2008 and 2011 and treated with SBRT or surgery were included. Crude survival and recurrence rates in both groups were evaluated and compared by Kaplan-Meier survival and Cox proportional hazard analyses. Since the selection of treatment is influenced by patients characteristics, we used the propensity score method to account for this bias. Propensity scores were estimated by a logistic regression model that included treatment as dependent variable and age, gender, performance status, FEV~1~, DLCO, nodule diameter and clinical TNM classification as independent variable. The propensity score was added as covariate to Cox proportional hazard analyses to adjust the outcome for patient characteristics.
Results:
The cohort treated with SBRT and surgery consisted of 53 and 175 patients, respectively. Before adjustment for the propensity score, the OS at 1 and 3 years after SBRT was 87% and 43% and after surgery 89% and 70% (HR = 2.42, 95% CI 1.65 – 3.56; p = 0.0001). The PFS at 1 and 3 years was 72% and 39% after SBRT and 80% and 60% after surgery (HR = 2.07; 95% CI 1.43 – 2.99; p = 0.0001). The locoregional recurrence rates at 1 year after SBRT and surgery were 94% and 95% and at 3 years for both 85% (HR = 1.43 ; 95% CI = 0.60 – 3.43; p = 0.42). The distant recurrence rates at 1 and 3 years after SBRT were 73% and 62% and after surgery 88% and 74% (HR = 1.67; 95% CI = 0.96 – 3.92; p = 0.07). After adjustment for the propensity score, the OS and PFS after SBRT were not significantly different compared with surgery (HR = 1.71, 95% CI 0.87 – 3.35; p = 0.12 respectively HR = 1.56; 95% CI 0.83 – 2.93; p = 0.17). The locoregional and distant recurrence rates between SBRT and surgery were also not significantly different (HR = 2.11; 95% CI = 0.56 – 7.75; p = 0.26 respectively HR = 1.24; 95% CI = 0.48 – 3.20; p = 0.65).
Conclusion:
This study shows that, after adjustment for the propensity score, the OS, PFS and recurrence rates after SBRT are not inferior compared with surgery in patients with stage I and II NSCLC. Although, we used the propensity score to reduce the effects of confounding by indication, randomized clinical trials are desired. Due to the lack of these trials, a thorough discussion of the patient individual merits and drawbacks of surgery and SBRT should be the cornerstone of the treatment.
