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J. Sonett
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P2.02 - Poster Session with Presenters Present (ID 462)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Locally Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 12/06/2016, 14:30 - 15:45, Hall B (Poster Area)
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P2.02-023 - Neoadjuvant Chemotherapy and Concurrent Full-Dose Radiation Therapy Followed by Surgery for Stage IIIB Non-Small Cell Carcinoma of the Lung (ID 3674)
14:30 - 14:30 | Author(s): J. Sonett
- Abstract
Background:
The role of neoadjuvant chemoradiation and surgery in patients with stage IIIB non-small cell lung cancer (NSCLC) is unclear. Previous studies have suggested that select patients may benefit from this trimodality approach. We retrospectively reviewed patients with stage IIIB NSCLC treated by trimodality intent with induction chemotherapy and concurrent full-dose radiation therapy followed by either surgery at our institution. Here we report survival and toxicity data in our cohort.
Methods:
Eight patients treated from 1999 to 2011 with neoadjuvant chemoradiation for stage IIIB NSCLC were included in the retrospective review. Five (63%) had pathologically proven N3 disease; 1 (13%) had radiographic evidence of N3 disease (2cm adenopathy with SUV>6); 2 (25%) had T4 disease due to involvement of multiple ipsilateral lobes. All 6 patients with N3 disease had minimal radiographically enlarged N3 nodes (fewer than 3) before treatment. Induction chemotherapy consisted of carboplatin or cisplatin doublet. Concurrent RT prescription consisted of 45Gy in 25 fractions to the mediastinum and primary tumor; most patients received a boost to at least 60Gy to gross disease. After re-evaluation, patients received surgery within three months of completion of induction therapy. Inoperable patients received consolidative chemotherapy.
Results:
Six patients (86%) received at least 59.4Gy to the primary tumor. Six patients underwent resection; 2 had pneumonectomy and 4 had lobectomy. A complete (R0) resection was achieved in all patients. Mediastinal nodal clearance (N2/3 negative) was seen in five (83%) patients. A complete pathological response was seen in three (50%) patients. With a median follow up of 45 months for all patients, the median overall survival (OS) was 52.8 months. The median progression-free survival (PFS) was 48.4 months. Median OS was 52.8 months for patients who achieved MNC, 5.7 months in one patient with residual mediastinal nodal disease (P=0.025), and 0.9 months in those who did not receive surgery. There was 1 grade 3 postoperative pulmonary complications and no treatment-related mortality within the follow up interval.
Conclusion:
Data from on our small cohort provide important preliminary evidence that neoadjuvant chemotherapy with concurrent full-dose radiation therapy followed by surgery may be a feasible treatment option for select patients with stage IIIB NSCLC. Toxicity is acceptable, and survival outcome compares favorably with that of patients with IIIA NSCLC treated with trimodality therapy.
