Author of

• 17493

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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)

  • 17527

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    P2.02-034 - Both Induction and Adjuvant Treatment Improve Outcomes of Surgically-Resected IIIA(N2) NSCLC When Compared to Definitive Chemoradiotherapy (ID 5546)

    14:30 - 14:30  |  Author(s): P.J. Villeneuve
    • Abstract

    Background:
    Determining the optimal treatment for stage IIIA(N2) non-small-cell lung cancer (NSCLC) has proven to be challenging and controversial, with considerable disagreement regarding the optimal management. The objective of this study was to compare the outcomes of patients treated with chemoradiotherapy (CRT) alone with those undergoing surgical resection wtih neoadjuvant (NE) or adjuvant (A) therapy for stage IIIA(N2) NSCLC at our institution.
    
    Methods:
    After approval from the institutional REB, data was collected from the Ottawa Hospital Data Warehouse by selecting all patients with lung cancer having received primary cancer treatment at our institution. We then excluded all patients without N2 nodal disease. Overall and recurrence-free survival at 5-years was assessed between NE and A for patients receiving surgery and those receiving CRT using Kaplan-Meier analyses and Cox proportional hazards modelling.
    
    Results:
    Over the period 2004-2014, we identified 526 lung cancer patients treated who had evidence of ipsilateral mediastinal nodal disease with 68 undergoing surgical resection. 458 patients underwent CRT alone. Surgical patients were on average younger (64.9 vs. 70 years) had less comorbid illnesses (Charlson index, 1.1 vs. 1.6). Incidentally-found (n=32) and single-station non-bulky (n=17) nodal disease were present in 84% of resections, where lobectomy (72%) was the most common resection. The rate of NE declined over time from >20% in 2004-8 to <3% in 2009-13 (p=0.015) while use of A remained stable (p=0.48). The overall median survival time was 19.9 months (95% CI: 17.6 to 23.0) and survival was greater among those NE and A therapies (log-rank test X[2] = 16.9, d.f.= 2, p=0.0002). Both NE and A were found to have lower hazard ratios compared to CRT only (HR 0.35 [95% CI: 0.13-0.95]; and 0.50 [95% CI: 0.33-0.77], respectively) after adjustment for age, Charlson score, year of diagnosis, and presence of multistation N2 disease. The results for recurrence-free survival were similar; median survival time was 11.9 months (95% CI: 11.0,13.6). Recurrence-free survival appears superior among those receiving surgery combined with NE or A compared to CRT alone (log-rank test X[2] = 19.8, d.f.= 2, p<0.0001).
    
    Conclusion:
    Both overall and disease-free survival are improved in surgically-resected IIIA(N2) NSCLC when employing either NE or A strategies. There was a trend for decreased use of NE treatments over time, which interestingly did not decrease the survival advantage observed over CRT alone. Our findings suggest that formal randomized comparison of NE versus A should be considered to further clarify the optimal treatment in surgically-resectable IIIA(N2) NSCLC.