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S.A. Hirji
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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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P2.03-021 - Impact of Radiation on Recurrence Patterns and Survival for Patients Undergoing Lobectomy for Stage IIIA-pN2 Non-Small Cell Lung Cancer (ID 2425)
09:30 - 09:30 | Author(s): S.A. Hirji
- Abstract
Background:
There is controversy regarding the optimal multimodality treatment strategy for stage IIIA-pN2 non-small cell lung cancer (NSCLC). This study evaluated the impact of induction and adjuvant radiation on locoregional and distant recurrence and survival when induction chemotherapy and surgery is used.
Methods:
Cancer recurrence and survival of 113 consecutive patients who were treated with lobectomy after induction chemotherapy ± radiation for pathologically staged IIIA-N2 NSCLC between 1995 and 2012 at a single institution were evaluated using Kaplan-Meier, logistic regression, and Cox proportional hazard analysis.
Results:
Induction radiation was used in 58 (51%) patients and adjuvant radiation was used in 29 (26%) patients (Table 1). For the entire cohort (n=113), median survival was 30.1 months (95% CI, 22.0 to 56.4). Five-year overall and recurrence-free survivals were 39.0% (95% CI, 29.1 to 48.7) and 28.2% (95% CI, 18.0 to 39.2), respectively. Recurrent disease occurred in 62 (55%) patients after a median (IQR) time of 11.5 months (4.3, 18.7) after surgery. First recurrence site was locoregional only (n=19), distant only (n=34), and locoregional and distant (n=9) (Table 1). In multivariable analysis, induction radiation was associated with decreased likelihood of developing locoregional recurrence (odds ratio (OR), 0.17; 95% CI: 0.04-0.90; p=0.04) but not improved survival (hazard ratio [HR], 1.47; 95% CI: 0.71-3.03; p=0.04) while adjuvant radiation was not associated with decreased likelihood of developing locoregional recurrence (OR, 0.48; 95% CI: 0.07-3.37; p=0.46) but was associated with improved survival (HR, 0.20; 95% CI: 0.04-0.91; p=0.04) (Table 2). Figure 1 Figure 2
Conclusion:
A significant number of recurrences in stage IIIA-pN2 NSCLC patients who undergo induction therapy followed by lobectomy are locoregional recurrences. Use of radiation was associated with improved local control only in the induction setting and may be optimal in terms of survival when given in the adjuvant rather than induction setting.
