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T. Tanaka
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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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P2.03-002 - Surgery for Locally Advanced Lung Cancer after Induction Concurrent Chemo-Radiation Therapy (ID 693)
09:30 - 09:30 | Author(s): T. Tanaka
- Abstract
Background:
The prognosis of locally advanced non-small-cell lung cancer is very poor. According to the American Cancer Society website, 5-year observed survival rate of Stage IIIA is 14%, and that of IIIB is 5%. A highly effective treatment strategy is needed to improve it. Surgery after induction concurrent chemo-radiation therapy for locally advanced non-small-cell lung cancer in our hospital over the last 8 years was retrospectively reviewed.
Methods:
Our standard induction chemo-radiation therapy consisted of cisplatin 40 mg/m[2] and docetaxel hydrate 40 mg/m[2] given on days 1, 8, 29, and 36 plus concurrent irradiation of 46 Gy (2 Gy/day) to the tumor, hilum, and mediastinum. Surgery was performed between 4 and 6 weeks after completion of the radiotherapy. 37 consecutive patients with 21 cases of lobectomy and 16 cases of pneumonectomy were reviewed. The median age at surgery was 62 (41 – 74) years old. There were 6 females and 31 males. Adenocarcinoma was present in 18, squamous cell carcinoma in 13, large cell neuroendocrine carcinoma in 2, adenosquamous cell carcinoma in 1, giant cell carcinoma in 1, NSCLC in 1, and atypical carcinoid which was preoperatively diagnosed as squamous cell carcinoma in 1. The pretreatment stage was IIIB in 11, IIIA in 20, IIB in 3, IIA in 1, and IB in 2. The pretreatment very high tumor marker levels in blood were as follows: CEA 367, 337, 266, 180, 154, 151, 105 ng/ml, CYFRA 47, 23, 20 ng/ml, and SCC 15, 10 ng/ml. Survival was calculated using the Kaplan-Meier method, and analyzed by the Log-Lank test.
Results:
Toxicity was manageable, and no serious complication was noted. All 37 cases were R0 resection. The median operation time of 21 cases of lobectomy and 16 cases of pneumonectomy were 5 hr 4 min and 4 hr 35 min, respectively. The median bleeding time of 21 cases of lobectomy and 16 cases of pneumonectomy were 200 ml and 175 ml, respectively. A pathologically complete response was obtained in 11 (30%) patients. The pathological stage was complete response in 11, IIIB in 3, IIIA in 6, IIB in 5, IIA in 4, IB in 2, and IA in 6. All abnormal blood tumor marker levels went down to normal. At a median follow-up period of 3 years 4 months (5 months - 8 years 8 month), 5-year survival rate of all 37 patients was 80%, and that of 21 lobectomy patients was 63%. Although 2 patients had recurrent tumors, 16 pneumonectomy patients were all alive without oxygen therapy. The prognosis of pneumonectomy was significantly better than lobectomy (p < 0.05).
Conclusion:
Surgery after induction concurrent chemo-radiation therapy for locally advanced non-small-cell lung cancer is feasible and highly effective. This treatment strategy has greatly improved the prognosis of locally advanced non-small-cell lung cancer.
