- Email: [email protected]
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Proceedings of the 48th Annual ASTRO Meeting
Conclusions: Radiotherapy for surgical non-small cell lung cancer patients is associated with improved survival for patients with ⱖ5 positive lymph nodes and for stage 3a patients with 1-4 positive lymph nodes, but with poorer survival in node negative patients.
Author Disclosure: J.C. Flickinger, None; A. Recht, None; M. DeCamp, None; A. Fritz, None; J. Varlotto, None.
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A Phase II Trial of Concurrent Paclitaxel and Carboplatin and Thoracic Radiotherapy in Resected Stage II and IIIA Non-Small Cell Lung Carcinoma
S. Feigenberg1, A. Hanlon2, C. Langer1, M. Goldberg1, N. Nicolaou1, M. Millenson1, L. Coia3, R. Lanciano4, B. Movsas5 1
Fox Chase Cancer Center, Philadelphia, PA, 2Temple University, Philadelphia, PA, 3Community Medical Center, Toms River, NJ, 4Delaware County Memorial Hospital, Drexel Hill, PA, 5Henry Ford Health System, Detroit, MI Purpose/Objective(s): To determine the feasibility of combining concurrent carboplatin(C)/ paclitaxel(P)and thoracic radiotherapy (TRT) for completely resected stage II and IIIA non-small cell lung cancer(NSCLC). Primary endpoints were local regional control (LRC) and overall survival (OS). Materials/Methods: Eligibility stipulated gross total resections with involved lymph nodes (N1 or N2) &endash; pathologic stage II or IIIA NSCLC. Patients with T4 tumors were excluded. TRT consisted of 50.4 Gy in 28 fractions with a boost of 10.8 Gy for extracapsular extension (ECE) or 16.2 Gy for involved surgical margins. Chemotherapy was administered every 3 weeks: C (AUC of 5) and P (175 mg/m2) during TRT for 2 cycles, with doses increased to AUC of 7.5 and 225 mg/m2 respectively for 2 cycles following TRT. Cox multivariate regression analysis (MVA) was used to confirm independent predictors of outcome among clinical and treatment related factors: age, T stage, N stage, presence of ECE, presence of involved surgical margins, cycles of chemotherapy, histopathology. Results: Between April 1997 and March 2001, 42 patients were enrolled. Two patients were deemed ineligible due to having T4 disease leaving 40 patients for analysis. Ninety-two percent (37/40) of patients had T1 or T2 disease; 60% (24/40) had N2 disease. Nine patients (22.5%) had ECE and 15% (6 patients) had involved surgical margins. At a median follow up of 37 months, range 3 - 103, (median 68 months for living patients), the 2 and 5 year Kaplan Meier estimates of LRC, Freedom from Distant Metastases (FFDM), Freedom from Brain Metastases (FFBM) and OS were 92% and 88%, 77% and 59%, 87% and 71% and 72% and 44%, respectively. Fourteen patients developed DM as the initial site of failure, 8 of whom had BM. BM was the only site of failure in 4 of the 8 patients. Multivariate analysis on OS demonstrated that patients receiving all 4 cycles of chemotherapy (p⫽0.0005) and patients with no evidence of ECE (p⫽0.02) had an improved OS.Multivariate analysis on FFDM demonstrated that higher N stage was the only independent predictor of DM (p⫽0.04). Multivariate analysis on FFBM demonstrated age was the only independent predictor of BM (p⫽0.02). With a median age of 66 years (range 45 to 75), no patient ⬎ 60 (0/23) developed BM opposed to (8/17) ⱕ 60. Treatment was tolerated reasonably well: 92% of patients (37/40) received the planned doses of TRT; 67% of patients (27/40) received all 4 cycles of chemotherapy. Five patients developed grade 3 esophagitis, while 3 patients experienced grade 3 pneumonitis. Two patients experienced grade 5 toxicity. One was treatment related due to a patient who developed grade 3 esophagitis who developed an aspiration pneumonia that progressed to ARDS. Conclusions: The results of RTOG 97-05 (Bradley et al JCO 2005) suggested that TRT administered concurrently with CP for patients may be better than TRT and concurrent Cisplatin and Etoposide (Keller et al NEJM 2000). Our results support the RTOG findings and suggest that with new and better tolerated chemotherapy regimens that the strategy of concurrent TRT and chemotherapy should be further explored.
Author Disclosure: S. Feigenberg, None; A. Hanlon, None; C. Langer, Bristol Myers Squibb, F. Consultant/Advisory Board; M. Goldberg, None; N. Nicolaou, None; M. Millenson, wife’s employer was Bristol Myers Squibb, G. Other; L. Coia, None; R. Lanciano, None; B. Movsas, None.
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Conclusions: Radiotherapy for surgical non-small cell lung cancer patients is associated with improved survival for patients with ⱖ5 positive lymph nodes and for stage 3a patients with 1-4 positive lymph nodes, but with poorer survival in node negative patients.
Author Disclosure: J.C. Flickinger, None; A. Recht, None; M. DeCamp, None; A. Fritz, None; J. Varlotto, None.
114
A Phase II Trial of Concurrent Paclitaxel and Carboplatin and Thoracic Radiotherapy in Resected Stage II and IIIA Non-Small Cell Lung Carcinoma
S. Feigenberg1, A. Hanlon2, C. Langer1, M. Goldberg1, N. Nicolaou1, M. Millenson1, L. Coia3, R. Lanciano4, B. Movsas5 1
Fox Chase Cancer Center, Philadelphia, PA, 2Temple University, Philadelphia, PA, 3Community Medical Center, Toms River, NJ, 4Delaware County Memorial Hospital, Drexel Hill, PA, 5Henry Ford Health System, Detroit, MI Purpose/Objective(s): To determine the feasibility of combining concurrent carboplatin(C)/ paclitaxel(P)and thoracic radiotherapy (TRT) for completely resected stage II and IIIA non-small cell lung cancer(NSCLC). Primary endpoints were local regional control (LRC) and overall survival (OS). Materials/Methods: Eligibility stipulated gross total resections with involved lymph nodes (N1 or N2) &endash; pathologic stage II or IIIA NSCLC. Patients with T4 tumors were excluded. TRT consisted of 50.4 Gy in 28 fractions with a boost of 10.8 Gy for extracapsular extension (ECE) or 16.2 Gy for involved surgical margins. Chemotherapy was administered every 3 weeks: C (AUC of 5) and P (175 mg/m2) during TRT for 2 cycles, with doses increased to AUC of 7.5 and 225 mg/m2 respectively for 2 cycles following TRT. Cox multivariate regression analysis (MVA) was used to confirm independent predictors of outcome among clinical and treatment related factors: age, T stage, N stage, presence of ECE, presence of involved surgical margins, cycles of chemotherapy, histopathology. Results: Between April 1997 and March 2001, 42 patients were enrolled. Two patients were deemed ineligible due to having T4 disease leaving 40 patients for analysis. Ninety-two percent (37/40) of patients had T1 or T2 disease; 60% (24/40) had N2 disease. Nine patients (22.5%) had ECE and 15% (6 patients) had involved surgical margins. At a median follow up of 37 months, range 3 - 103, (median 68 months for living patients), the 2 and 5 year Kaplan Meier estimates of LRC, Freedom from Distant Metastases (FFDM), Freedom from Brain Metastases (FFBM) and OS were 92% and 88%, 77% and 59%, 87% and 71% and 72% and 44%, respectively. Fourteen patients developed DM as the initial site of failure, 8 of whom had BM. BM was the only site of failure in 4 of the 8 patients. Multivariate analysis on OS demonstrated that patients receiving all 4 cycles of chemotherapy (p⫽0.0005) and patients with no evidence of ECE (p⫽0.02) had an improved OS.Multivariate analysis on FFDM demonstrated that higher N stage was the only independent predictor of DM (p⫽0.04). Multivariate analysis on FFBM demonstrated age was the only independent predictor of BM (p⫽0.02). With a median age of 66 years (range 45 to 75), no patient ⬎ 60 (0/23) developed BM opposed to (8/17) ⱕ 60. Treatment was tolerated reasonably well: 92% of patients (37/40) received the planned doses of TRT; 67% of patients (27/40) received all 4 cycles of chemotherapy. Five patients developed grade 3 esophagitis, while 3 patients experienced grade 3 pneumonitis. Two patients experienced grade 5 toxicity. One was treatment related due to a patient who developed grade 3 esophagitis who developed an aspiration pneumonia that progressed to ARDS. Conclusions: The results of RTOG 97-05 (Bradley et al JCO 2005) suggested that TRT administered concurrently with CP for patients may be better than TRT and concurrent Cisplatin and Etoposide (Keller et al NEJM 2000). Our results support the RTOG findings and suggest that with new and better tolerated chemotherapy regimens that the strategy of concurrent TRT and chemotherapy should be further explored.
Author Disclosure: S. Feigenberg, None; A. Hanlon, None; C. Langer, Bristol Myers Squibb, F. Consultant/Advisory Board; M. Goldberg, None; N. Nicolaou, None; M. Millenson, wife’s employer was Bristol Myers Squibb, G. Other; L. Coia, None; R. Lanciano, None; B. Movsas, None.
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