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G. Simontacchi
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P3.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 211)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.02-024 - Lobectomy versus Stereotactic Ablative Radiotherapy (SABR) for Stage I Non Small Cell Lung Cancer (NSCLC) in 182 Patients (ID 2781)
09:30 - 09:30 | Author(s): G. Simontacchi
- Abstract
Background:
Data from prospective randomized clinical trials are lacking in the comparison between lobectomy (L) and SABRT in operable patients and ongoing trials have troubles in recruiting. In inoperable patients a local control of 64-95% in retrospective and 92-98% in prospective trial is reported when BED is over 100 Gy.
Methods:
From 2003 to 2013, 182 I-IIA NSCLC patients were treated at our Institution. Clinical characteristics are summarized in table I; cyto-histological prove of NSCLC was available in all surgical patients and in 61/88 (69%) SABRT patients. Spirometry was available in 120/182 (66%). Response was evaluated according to RECIST criteria after primary treatment. Toxicity was graduated according to CTCAE version 4 criteria.RT Surg Total p^ n=88 (%) n=94 (%) n=182(%) Gender Male 70(79.5) 61(64.9) 131(72.0) 0.032 Female 18(20.5) 33(35.1) 51(28.0) Age (median) <72 26(29.5) 67(71.3) 93(51.1) 0.0001 >72 62(70.5) 27(28.7) 89(48.9) Hystology Adenocarcinoma 36(59.0) 69(73.4) 105(67.7) 0.14 SCC 23(37.7) 24(25.5) 47(30.4) Large Cell Carcinoma 2(3.3) 1(1.1) 33(18.1) Performance Status 0 13(14.8) 62(66.0) 75(41.2) 0.0001 1 45(51.1) 29(30.9) 74(40.7) 2 30(34.1) 3(3.1) 33(18.1) FEV1 <1.5 35(43.8) 7(17.5) 42(35.0) 0.005 >1.5 45(56.2) 33(82.5) 78(65.0)
Results:
Median follow-up time was 25 months (range: 6-110). Three local relapses (LR) were observed in L and 18 in SABRT group (p=0,0001). No difference in distant metastases was observed (19 in L vs 18 in SABRT group) (p=1-data not shown). Results of univariate survival analysis are shown in table II. Multivariate analysis confirmed the protective effect of L on OS and of good FEV1 (>1,5L) on DFS. A subgroup comparison of SABRT patients treated with BED>100Gy vs surgical patients showed no difference in local control (LC) (p=0,60) while OS and tumor-specific survival (TSS) remain in favor of L (p=0,001 and 0,049 respectively). Moreover, comparing surgical patients with SABRT with known histology and BED>100 Gy no difference was seen in TSS (p=0.10) nor in LC (p=0,36). No grade 3-5 toxicity was observed in both group.Died % OS p^ LR % DFS p^ Age (median) <72 26 56.1 0.001 10 84.3 0.50 >72 50 10 11 79.9 Hystology Adenocarcinoma 34 37.9 0.66 9 87 0.81 SCC 22 35 3 91.2 Large Cell Carcinoma 1 66.7 0 100 Performance Status 0 17 59.8 0.001 7 87.3 0.52 1 29 19 9 79.5 2 3 18.3 5 81 FEV1 <1.5 27 20.4 0.14 11 86.2 0.005 >1.5 37 14 7 80.9 Treatment Radiotherapy 62 4.4 0.0001 18 67.4 0.0001 Surgery 14 72.9 3 95.1 Total 76 12.2 21 82.4
Conclusion:
SABRT with adequate doses vs L in operable patients shows promising results in terms of LC and TSS with few toxicitiy. OS is mainly influenced by the selection of patients addressed to L vs SABRT.
