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Outcomes in Patients With Stage III Non-Small Cell Lung Cancer Treated With Neoadjuvant Concurrent Chemotherapy and Radiation Therapy Followed by Surgical Resection
E414
International Journal of Radiation Oncology Biology Physics
Results: A total of 210 patients were identified. The median follow up was 6.8 years. There were 60 stage I (28.6%), 108 stage II (51.4%), 35 stage III (16.7%) and 7 stage IV (3.3%). Histological subtypes were; 23 type A (11%), 48 type AB (22.9%), 34 type B1 (16.2%), 65 type B2 (31%) and 40 type B3 (19%). Ninety-nine patients underwent surgery alone (47.1%) and 111 underwent surgery and adjuvant RT (52.9%). The 10 year OS was 82.2% for surgery compared to 90.1% for surgery and RT (pZ0.763). The 10 year DFS was 79.7% and 80.8% respectively (pZ0.797). Subgroup analysis of patients with R1/R2 resections showed the 10 year OS of 53.6% with surgery and 91.8% with surgery and RT (pZ0.005). The 10 year DFS was 57.1% and 78.1% (0.088) respectively. No differences were found in FFR or TTP between two treatment groups. Both univariate and multivariate analysis showed age, presence of Myasthenia Gravis (MG) and Masaoka stage (I/II versus III/IV) as significant factors associated with OS. Masaoka stage alone was significant for DFS. Histological subtypes (A/ AB/B1 versus B2/B3) had no prognostic impact on survivals; OS pZ0.730, DFS pZ0.072. Conclusion: Adjuvant RT improved OS and DFS in R1/R2 resections. Age, presence of MG and Masaoka stage were found as significant factors associated with overall survival in thymoma. Author Disclosure: S. Kim: None. S. Yong: None. A.M. Takano: None. I. Sng: None. A. Thiagarajan: None. S. Yap: None. T. Siow: None. C. Lim: None. T. Agasthian: None. W. Ng: None. K.L. Chua: None. K. Fong: None.
Conclusion: Trimodality therapy results in good rates of OS, DFS, LRFS, and RRFS with high rates of pathologic complete response. Patient selection is important in achieving good outcomes. Author Disclosure: V. Yau: None. M.E. Giuliani: Travel Expenses; Elekta. O. Wong: None. L.W. Le: None. G. Darling: None. F. Shepherd: None. A.M. Brade: None. J. Cho: None. A. Sun: None. A. Bezjak: None. A.J. Hope: Travel Expenses; Elekta.
3031 Outcomes in Patients With Stage III Non-Small Cell Lung Cancer Treated With Neoadjuvant Concurrent Chemotherapy and Radiation Therapy Followed by Surgical Resection V. Yau,1 M.E. Giuliani,2 O. Wong,3 L.W. Le,3 G. Darling,4 F. Shepherd,1 A.M. Brade,3 J. Cho,2 A. Sun,5 A. Bezjak,3 and A.J. Hope2; 1University of Toronto, Toronto, ON, Canada, 2Princess Margaret Cancer Centre / University of Toronto, Toronto, ON, Canada, 3Princess Margaret Cancer Centre, Toronto, ON, Canada, 4Toronto General Hospital, University Health Network, Toronto, ON, Canada, 5Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada Purpose/Objective(s): To examine outcomes in patients with stage III Non-Small Cell Lung Cancer who underwent trimodality therapy (concurrent neoadjuvant chemoradiation therapy followed by surgical resection) Materials/Methods: Retrospective review of a single institution database to identify all patients with stage III NSCLC treated from 1996-2012 with trimodality therapy. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method from the date of surgery. Univariable and multivariable analyses using Cox proportional hazards regression were used to assess demographic, disease, and treatment factors for association with OS, DFS, regional recurrence free survival (RRFS) and local recurrence free survival (LRFS). Results: 154 patients were included in the analysis. Median age was 60.5 years. 99% were ECOG performance status 0-1. 145 (94%) patients were stage IIIA and 9 (6%) were stage IIIB. 70% had N2 disease and 23% had N0 disease. Radiation therapy dose ranged from 43.2Gy-70Gy. 127 (82%) of patients received 45Gy. 84% of patient underwent lobectomy and 16% pneumonectomy. Median follow-up was 50 months. Median OS was 49.5 months. The 2-year and 5-year OS were 67% and 47% respectively. The 2year and 5-year DFS were 51% and 39% respectively. Treatment-related toxic deaths (8/154) were all attributed to post-operative complications; 5 were post pneumonectomy and 3 post lobectomy. 49/75 deceased patients (65%) died of lung cancer. On multivariate analysis, patients who underwent lobectomy had higher OS (pZ0.02), DFS (pZ0.01), LRFS (pZ0.01) and RRFS (pZ0.01) compared to pneumonectomy. 65 (43%) patients achieved pathological complete or near complete response (defined as 5% residual) in the primary tumor. Of the 104 patients who had evaluable nodal disease, 48 (46%) patients demonstrated pathological complete response.
3032 Imaging Based Parameters Associated With Disease Progression of Early-Stage NSCLC Treated With Surgical Resection A. Wang,1 R. von Eyben,2 B.W. Loo, Jr,3 M. Diehn,1 J.B. Shrager,4 P.G. Maxim,1 H.H. Guo,1 B. Burt,5 and D.B. Shultz1; 1Stanford University School of Medicine, Stanford, CA, 2Stanford Cancer Institute, Stanford, CA, 3Stanford University, Stanford, CA, 4Stanford University School of Medicine, Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford, CA, 5Baylor College of Medicine, Houston, TX Purpose/Objective(s): We previously identified a set of imaging-based biomarkers that independently correlated to distant metastasis in a cohort of stage I non-small cell lung cancer (NSCLC) patients treated with stereotactic ablative radiation therapy (SABR). Here we aimed to investigate whether these same features are prognostic for outcome among patients treated with surgical resection. Materials/Methods: We identified 140 consecutively treated patients who underwent surgical resection at Stanford University for NSCLC (May 2003 to February 2014) with the following inclusion criteria: fluorine-18 fluorodeoxyglucose positron-emission tomography (PET) scan prior to surgery, Stage I-IIA, follow-up at least 3 months, and no adjuvant chemotherapy or radiation therapy. Median follow-up was 26.7 months (range 3.3-104.6). Cox proportional hazards models were used to correlate survival to prespecified imaging features [SUVmax, maximum dimension, and contact with mediastinal pleura (MP)]. Results: Seventeen patients developed distant progression (2-year cumulative incidence 0.099), ten developed regional progression, four developed local progression, and eleven died. Maximum tumor dimension (pZ0.015), SUVmax (p < 0.0001), and MP (pZ0.0013) were significantly associated with distant progression on univariate analysis. In a multivariate model, MP (pZ0.074) and SUVmax (pZ0.016) remained correlated to distant progression, whereas maximum tumor dimension did not (pZ0.22). A previously developed model for distant progression using a distant metastasis risk score (DMRS) in the SABR cohort incorporating MP, SUVmax, and dimension was also prognostic in this cohort (p<0.0001). In the competing risk model, patients with DMRS>3.6 (previously defined optimal cut point in the SABR cohort) had a significantly higher cumulative incidence of distant progression than patients with DMRS<3.6 (pZ0.0031). Conclusion: SUVmax and MP were strongly associated with distant disease progression in a cohort of early-stage NSCLC patients treated with surgery. A model incorporating SUVmax, MP, and tumor dimension previously developed for SABR patients has now been validated in an independent surgery cohort. Use of these imaging parameters is a non-invasive method to identify patients at high risk for metastases who may benefit from adjuvant systemic therapy. Author Disclosure: A. Wang: None. R. von Eyben: None. B.W. Loo: None. M. Diehn: None. J.B. Shrager: None. P.G. Maxim: None. H.H. Guo: None. B. Burt: None. D.B. Shultz: None.
3033 Outcomes of Hypofractionation for Early-Stage and Locally Recurrent Non-Small Cell Lung Cancer: Experience From a Multidisciplinary Thoracic Oncology Program at a NCI Designated Cancer Center J. Walker, J.M. Holland, M. Deffebach, S. Mongoue-Tchkote, J.A. Tanyi, C.R. Thomas, Jr, and C. Dai Kubicky; Oregon Health and Science University, Portland, OR
International Journal of Radiation Oncology Biology Physics
Results: A total of 210 patients were identified. The median follow up was 6.8 years. There were 60 stage I (28.6%), 108 stage II (51.4%), 35 stage III (16.7%) and 7 stage IV (3.3%). Histological subtypes were; 23 type A (11%), 48 type AB (22.9%), 34 type B1 (16.2%), 65 type B2 (31%) and 40 type B3 (19%). Ninety-nine patients underwent surgery alone (47.1%) and 111 underwent surgery and adjuvant RT (52.9%). The 10 year OS was 82.2% for surgery compared to 90.1% for surgery and RT (pZ0.763). The 10 year DFS was 79.7% and 80.8% respectively (pZ0.797). Subgroup analysis of patients with R1/R2 resections showed the 10 year OS of 53.6% with surgery and 91.8% with surgery and RT (pZ0.005). The 10 year DFS was 57.1% and 78.1% (0.088) respectively. No differences were found in FFR or TTP between two treatment groups. Both univariate and multivariate analysis showed age, presence of Myasthenia Gravis (MG) and Masaoka stage (I/II versus III/IV) as significant factors associated with OS. Masaoka stage alone was significant for DFS. Histological subtypes (A/ AB/B1 versus B2/B3) had no prognostic impact on survivals; OS pZ0.730, DFS pZ0.072. Conclusion: Adjuvant RT improved OS and DFS in R1/R2 resections. Age, presence of MG and Masaoka stage were found as significant factors associated with overall survival in thymoma. Author Disclosure: S. Kim: None. S. Yong: None. A.M. Takano: None. I. Sng: None. A. Thiagarajan: None. S. Yap: None. T. Siow: None. C. Lim: None. T. Agasthian: None. W. Ng: None. K.L. Chua: None. K. Fong: None.
Conclusion: Trimodality therapy results in good rates of OS, DFS, LRFS, and RRFS with high rates of pathologic complete response. Patient selection is important in achieving good outcomes. Author Disclosure: V. Yau: None. M.E. Giuliani: Travel Expenses; Elekta. O. Wong: None. L.W. Le: None. G. Darling: None. F. Shepherd: None. A.M. Brade: None. J. Cho: None. A. Sun: None. A. Bezjak: None. A.J. Hope: Travel Expenses; Elekta.
3031 Outcomes in Patients With Stage III Non-Small Cell Lung Cancer Treated With Neoadjuvant Concurrent Chemotherapy and Radiation Therapy Followed by Surgical Resection V. Yau,1 M.E. Giuliani,2 O. Wong,3 L.W. Le,3 G. Darling,4 F. Shepherd,1 A.M. Brade,3 J. Cho,2 A. Sun,5 A. Bezjak,3 and A.J. Hope2; 1University of Toronto, Toronto, ON, Canada, 2Princess Margaret Cancer Centre / University of Toronto, Toronto, ON, Canada, 3Princess Margaret Cancer Centre, Toronto, ON, Canada, 4Toronto General Hospital, University Health Network, Toronto, ON, Canada, 5Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada Purpose/Objective(s): To examine outcomes in patients with stage III Non-Small Cell Lung Cancer who underwent trimodality therapy (concurrent neoadjuvant chemoradiation therapy followed by surgical resection) Materials/Methods: Retrospective review of a single institution database to identify all patients with stage III NSCLC treated from 1996-2012 with trimodality therapy. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method from the date of surgery. Univariable and multivariable analyses using Cox proportional hazards regression were used to assess demographic, disease, and treatment factors for association with OS, DFS, regional recurrence free survival (RRFS) and local recurrence free survival (LRFS). Results: 154 patients were included in the analysis. Median age was 60.5 years. 99% were ECOG performance status 0-1. 145 (94%) patients were stage IIIA and 9 (6%) were stage IIIB. 70% had N2 disease and 23% had N0 disease. Radiation therapy dose ranged from 43.2Gy-70Gy. 127 (82%) of patients received 45Gy. 84% of patient underwent lobectomy and 16% pneumonectomy. Median follow-up was 50 months. Median OS was 49.5 months. The 2-year and 5-year OS were 67% and 47% respectively. The 2year and 5-year DFS were 51% and 39% respectively. Treatment-related toxic deaths (8/154) were all attributed to post-operative complications; 5 were post pneumonectomy and 3 post lobectomy. 49/75 deceased patients (65%) died of lung cancer. On multivariate analysis, patients who underwent lobectomy had higher OS (pZ0.02), DFS (pZ0.01), LRFS (pZ0.01) and RRFS (pZ0.01) compared to pneumonectomy. 65 (43%) patients achieved pathological complete or near complete response (defined as 5% residual) in the primary tumor. Of the 104 patients who had evaluable nodal disease, 48 (46%) patients demonstrated pathological complete response.
3032 Imaging Based Parameters Associated With Disease Progression of Early-Stage NSCLC Treated With Surgical Resection A. Wang,1 R. von Eyben,2 B.W. Loo, Jr,3 M. Diehn,1 J.B. Shrager,4 P.G. Maxim,1 H.H. Guo,1 B. Burt,5 and D.B. Shultz1; 1Stanford University School of Medicine, Stanford, CA, 2Stanford Cancer Institute, Stanford, CA, 3Stanford University, Stanford, CA, 4Stanford University School of Medicine, Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford, CA, 5Baylor College of Medicine, Houston, TX Purpose/Objective(s): We previously identified a set of imaging-based biomarkers that independently correlated to distant metastasis in a cohort of stage I non-small cell lung cancer (NSCLC) patients treated with stereotactic ablative radiation therapy (SABR). Here we aimed to investigate whether these same features are prognostic for outcome among patients treated with surgical resection. Materials/Methods: We identified 140 consecutively treated patients who underwent surgical resection at Stanford University for NSCLC (May 2003 to February 2014) with the following inclusion criteria: fluorine-18 fluorodeoxyglucose positron-emission tomography (PET) scan prior to surgery, Stage I-IIA, follow-up at least 3 months, and no adjuvant chemotherapy or radiation therapy. Median follow-up was 26.7 months (range 3.3-104.6). Cox proportional hazards models were used to correlate survival to prespecified imaging features [SUVmax, maximum dimension, and contact with mediastinal pleura (MP)]. Results: Seventeen patients developed distant progression (2-year cumulative incidence 0.099), ten developed regional progression, four developed local progression, and eleven died. Maximum tumor dimension (pZ0.015), SUVmax (p < 0.0001), and MP (pZ0.0013) were significantly associated with distant progression on univariate analysis. In a multivariate model, MP (pZ0.074) and SUVmax (pZ0.016) remained correlated to distant progression, whereas maximum tumor dimension did not (pZ0.22). A previously developed model for distant progression using a distant metastasis risk score (DMRS) in the SABR cohort incorporating MP, SUVmax, and dimension was also prognostic in this cohort (p<0.0001). In the competing risk model, patients with DMRS>3.6 (previously defined optimal cut point in the SABR cohort) had a significantly higher cumulative incidence of distant progression than patients with DMRS<3.6 (pZ0.0031). Conclusion: SUVmax and MP were strongly associated with distant disease progression in a cohort of early-stage NSCLC patients treated with surgery. A model incorporating SUVmax, MP, and tumor dimension previously developed for SABR patients has now been validated in an independent surgery cohort. Use of these imaging parameters is a non-invasive method to identify patients at high risk for metastases who may benefit from adjuvant systemic therapy. Author Disclosure: A. Wang: None. R. von Eyben: None. B.W. Loo: None. M. Diehn: None. J.B. Shrager: None. P.G. Maxim: None. H.H. Guo: None. B. Burt: None. D.B. Shultz: None.
3033 Outcomes of Hypofractionation for Early-Stage and Locally Recurrent Non-Small Cell Lung Cancer: Experience From a Multidisciplinary Thoracic Oncology Program at a NCI Designated Cancer Center J. Walker, J.M. Holland, M. Deffebach, S. Mongoue-Tchkote, J.A. Tanyi, C.R. Thomas, Jr, and C. Dai Kubicky; Oregon Health and Science University, Portland, OR